The impact of large proximal aortic neck on endovascular aneurysm repair outcomes.

Background: This study aims to investigate the effect of large proximal aortic neck diameter on post-endovascular aneurysm repair clinical outcomes. Methods: A total of 180 patients (168 males, 12 females; mean age: 69.9±7.4 years; range, 46 to 88 years) who underwent elective endovascular aneurysm repair between June 2016 and September 2021 were retrospectively analyzed. According to the proximal infrarenal aortic neck diameter, the patients were divided into two groups: Group 1 (<25 mm; normal aortic neck) and Group 2 (≥25 mm; pre-aneurysmatic aortic neck). Patient characteristics, proximal infrarenal aortic neck diameter measurements with computed tomography angiography, and clinical outcomes were recorded. The primary endpoint was to assess post-endovascular aneurysm repair aortic neck dilatation, mortality, endoleaks, overall survival, type 1a endoleaks-free survival, and eventfree survival regarding the groups. Results: There was no statistically significant difference in early mortality (p=0.55) and type 1a endoleak incidence between the groups (p=0.55). In Group 1, the mean change in diameter A (proximal infrarenal level) was 2.89±1.74 mm (p=0.01), and it was 2.31±2.1 mm in diameter B (proximal pre-aneurysm-sac level) (p=0.01). The mean change in Group 2 was 2.8±3.4 mm for diameter A (p<0.01) and 2.22±2.3 mm for diameter B (p<0.01). Aortic neck dilatation rates were similar between the groups (p=0.82 for diameter A; p=0.78 for diameter B). The five-year survival, event-free survival, and type 1a endoleak-free survival were also similar (p=0.54, p=0.26, p=0.24, respectively). Conclusion: Our study results showed that patients with <25 mm and ≥25-mm aortic neck diameters had similar mid-term results and aortic neck dilatation ratio. Endovascular aneurysm repair outcomes can be improved with careful patient and graft selection, and early intervention for complications.

Evaluation of endovascular treatment of chronic limb-threatening ischemia for patients in the PLAN gray zone.

OBJECTIVE: To compare the results of endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients categorized under the gray and yellow zones of the patient risk, limb severity, and anatomic pattern (PLAN) concept over a 2-year follow-up period. METHODS: Patients who underwent endovascular therapy for peripheral artery disease and presented with CLTI from February 2017 to February 2019 were retrospectively reviewed. The patients were grouped into yellow and gray zones based on the PLAN concept. Preoperative and postoperative walking distances, Rutherford classes, and postoperative target vessel patency rates were recorded and compared between the groups. Follow-up evaluations were performed at 1, 6, 12, and 24 months post-procedure. RESULTS: Of the 387 patients evaluated, the yellow and gray groups comprised 88 patients each. The overall patency rates were similar between the groups (84 (95.45%) vs. 81 (92.05%), respectively). The occlusion-/stenosis-free survival times, amputation-free survival time, and mean survival time were not significantly different. However, the gray group had a significantly higher number of atherectomy interventions (74 vs. 59) and crosser devices used (62 vs. 42). CONCLUSION: Endovascular therapy is an effective treatment option for patients in the gray zone of the PLAN color coding system.

Combined Endovascular Treatment of Complex Aortic Pathologies.

AIM: Multisegmented aortic pathologies present challenging issues independent of the treatment chosen. Whether open or endovascular, staged, or simultaneous, every treatment modality has its own pros and cons. We revealed our patients retrospectively with early and midterm results who had simultaneous endovascular thoracic and abdominal aortic repair for thoracic aortic pathologies and infrarenal abdominal aortic aneurysm (iAAA) as a single-center experience. MATERIALS AND METHODS: Between January 2016 and January 2021, 16 patients were diagnosed with thoracic aortic pathology and iAAA was simultaneously repaired in an endovascular manner. All patients were operated on with the same cardiovascular surgeon team. RESULTS: The average age of the patients were 76.9 ± 6.2 (64-86) years. There was no early mortality. The technical success was 100%. In total, 18 thoracic endografts were deployed in 16 patients for thoracic aortic pathologies. Follow-up period was 21.85 ± 8.96 months, and in the follow-up period, two patients had a secondary intervention. One cardiac and one coronavirus disease 2019 mortality was detected in the follow-up period. There was no aneurysm-related mortality. The postoperative first-year survival was 84.6 ± 10.0. CONCLUSION: Simultaneous endovascular solution for complex multisegmented aortic pathologies provides a rapid, less-invasive approach with successful early and midterm morbidity, mortality with short intensive care unit period, and length of hospital stay. A combination of endovascular aortic aneurysm repair and thoracic endovascular aortic repair where anatomic suitability exists is a strong alternative over staged and hybrid therapies. Contrast-induced nephropathy, postimplantation syndrome, and spinal cord ischemia should be carefully monitored with this strategy.

Tips and tricks about surgeon-modified fenestrated stent grafting for celiac truncus.

Currently, thoracic endovascular aortic repair is usually the first-line treatment option for descending aortic pathologies. Supra-aortic or visceral branches sometimes involve assistive thoracic endovascular aortic repair techniques; hybrid procedures or intentional coverage may be performed during the procedure to achieve a sufficient proximal or distal landing zone. Most surgeons may agree on selective coverage of celiac truncus, but revascularization is preferred to reduce the risk of ischemic complications. Herein, we present the first successful surgeonmodified fenestrated stent graft procedure for celiac truncus in a patient with Crawford type V descending aortic aneurysm in Türkiye.

Early and Midterm Outcomes of Endovascular Treatment in Arterial Manifestations of Vascular Behcet Disease.

BACKGROUND: Behcet's disease (BD), originally described by Hulusi Behcet in 1937, is a chronic relapsing inflammatory process of an immunologic syndrome and the involvement of the vascular system is called Vasculo-Behcet disease (VBD). This is a retrospective study evaluating 21 patients diagnosed with VBD who underwent endovascular treatment. METHODS: This single-center study was conducted between January 2016 and January 2022. Early and mid-term endovascular outcomes of a total of 21 patients (16 males, 5 females with a median age of 42 years; range, 31 to 46 years), with a diagnosis of VBD, who underwent endovascular arterial repair in our hospital, were retrospectively analyzed. Follow-ups were scheduled for the first and sixth postoperative months and every 6 months thereafter. For symptomatic patients, imaging studies and additional interventions were planned. The primary outcomes were a procedural success and a requirement for reintervention. Secondary outcomes were complications and all causes of mortality. RESULTS: Twenty-one patients underwent endovascular repair. In this study, 1 balloon-expandable stent for brachial artery aneurysm (4,8%), 1 viabahn graft for femoral artery aneurysm (4,8%), 2 tube endograft for ruptured iliac artery aneurysm (9,5%), 1 tube endograft (Thoracic endovascular aortic repair [TEVAR]) insertion at the aortic bifurcation for infrarenal abdominal aortic occlusion (4,8%), 1 chimney-TEVAR for saccular arcus thoracic aortic aneurysm (TAA) (4,8%) and 7 TEVAR for saccular TAA (33,3%), 1 EVAR for an intact and symptomatic infrarenal abdominal aortic aneurysm (AAA) (4,8%), 1 EVAR (aorto-uniiliac) for ruptured iliac artery aneurysm (4,8%), and 6 EVAR for ruptured AAA (28,5%) were deployed. The technical success rate was 100% with a mean follow-up period of 50. 4 ± 10.7 months (8-66 months). The mean aneurysm diameter was 10,7 ± 53 mm. In the follow-up period, 3 patients presented with a hematoma at the insertion site of the sheath (14.3%). There were no early mortalities. Three patients required reintervention (14,3%); 1 of these underwent open surgical repair due to a pseudoaneurysm of the access site (4,8%). The Kaplan-Meier analysis revealed freedom from reintervention rate as 94,1 ± 5,7% at 1 year, 85,6 ± 9,7% at 3 years, and 68,4 ± 17,1% at 5 years. CONCLUSIONS: Awareness of the BD especially for vascular involvements in young ages is lifesaving. Endovascular therapy with proper medical treatment seems to be the treatment of choice according to the early and midterm successful results with low morbidity and mortality.

Anterior and Posterior Pulmonary Cusp Augmentation in the Repair of Tetralogy of Fallot.

BACKGROUND: In this retrospective study, we compared the results from 2 pulmonary valve augmentation techniques in patients undergoing surgical repair of tetralogy of Fallot. METHODS: Between 2015 and 2018, 18 patients had anterior pulmonary valve repair at our institution, and 26 patients had both anterior and posterior pulmonary valve repair. RESULTS: Patients ranged from 6 months to 30 years of age. The median follow-up period was 8 months in the anterior augmentation group and 5 months in the anterior and posterior augmentation group. Postoperative echocardiograms indicated that only 2 patients (11%) in the anterior augmentation group had moderate or severe pulmonary insufficiency, compared with no patients in the anterior and posterior augmentation group. At follow-up, pulmonary insufficiency was seen in 3 patients (17%) in the anterior augmentation group and no patients in the anterior and posterior augmentation group. CONCLUSION: Reconstruction of the native pulmonary valve accompanied by pulmonary cusp augmentation can decrease or even circumvent postoperative pulmonary insufficiency. Both anterior augmentation and anterior and posterior augmentation techniques are easily applied; however, we believe that the anterior and posterior augmentation technique is superior in terms of early postoperative and follow-up pulmonary insufficiency outcomes.

Predicting postoperative ischemic stroke problems in patients following coronary bypass surgery using neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and red blood cell distribution width values.

Introduction: Coronary artery bypass grafting (CABG) plays an important role in the revascularization of ischemic heart disease. However, stroke is a rare but extremely serious complication after CABG. Aim: We investigated the relationship between platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio, red blood cell distribution width (RDW) values, and postoperative ischemic stroke by examining the preoperative complete blood count (CBC) parameters in patients who underwent CABG. Material and methods: A total of 1240 patients who underwent CABG between September 2016 and June 2019 were included in this retrospective observational study. The diagnosis of ischemic stroke was made in the postoperative period by neurology consultation and radiological imaging. The CBC data used as preoperative values for each case were obtained the day before surgery. Results: Ischemic stroke was observed in 40 patients. In patients with stroke, the mean age was higher, the hemoglobin (HB) value and lymphocyte count were lower (p < 0.001), and there were also higher neutrophil to lymphocyte ratio (NLR), PLR, and RDW values (p < 0.001), number of mechanical ventilator days, length of stay in the hospital, and length of stay in the ICU (p < 0.001). Statin and acetylsalicylic acid use were statistically significantly higher in patients without ischemic stroke after CABG (p < 0.001); the use of other antiaggregants was found to be higher in stroke patients (p < 0.05). However, age, operation time, PLR, NLR, and RDW values were determined as independent risk factors for ischemic stroke. Conclusions: In patients undergoing CABG, high preoperative PLR, NLR, and RDW values can be used as useful and independent risk factors for the prediction of postoperative ischemic stroke.

Therapeutic Role of Astaxanthin and Resveratrol in an Experimental Rat Model of Supraceliac Aortic Ischemia-Reperfusion.

OBJECTIVE: The aim of the study is to investigate the therapeutic effects of astaxanthin (AST) and resveratrol (RVT) on multiorgan damage in an animal model of the supraceliac aortic ischemia-reperfusion (I/R). METHODS: In this study, 28 rats (n = 7/group), 200 to 250 g in weight, were randomized to four groups (1: Sham, 2: Control + I/R, 3: AST + I/R, and 4: RVT + I/R). Following the abdominal incision, aortic dissection was performed in the sham group without injury. Other groups underwent I/R injury via supraceliac aortic clamping (20 minutes) and reperfusion. The rats were administered olive oil (3 mL/kg) orally for 2 weeks before and 1 week after the laparotomy. Additionally, oral AST (10 mg/kg) or RVT (50 mg/kg) was given to the study groups. All rats were sacrificed on the 3rd week of the experiment after blood samples were taken for analysis. Multiple rat tissues were removed. RESULTS: We found that RVT increased total antioxidant status (TAS) and superoxide dismutase (SOD) levels, and decreased total oxidant status (TOS), oxidative stress index (OSI), myeloperoxidase (MPO), and malondialdehyde (MDA) levels, while AST increased the levels of TAS, decreased TNF-α, MDA, TOS, and OSI (p <0.05). Pathological investigations of the rat tissues revealed that both AST and RVT ameliorated tissue damage and apoptosis. CONCLUSION: Our study suggests that AST and RVT might show therapeutic effects against oxidative tissue damage and apoptosis in an animal model of aortic I/R. Further studies are required. KEY POINTS: · Major congenital heart diseases are at high risk of multiorgan damage.. · Re-establishment of blood flow may result in ischemia-reperfusion (I/R) injury.. · Astaxanthin and resveratrol may have therapeutic effects against I/R injury..

Protective role of melatonin and spirulina in aortic occlusion-reperfusion model in rats.

The aim of this experiment was to investigate the role of melatonin and spirulina on multiorgan damage induced by ischemia/reperfusion injury (IR) in a rat model. A total of 32 male rats weighing 200-220 g were allocated into 4 groups (n = 8/group) (Sham, Control-IR [CIR], Melatonin-IR [MIR], and Spirulina-IR [SIR]). Sham group underwent midline laparotomy and dissection of the aorta without injury. In other groups, an IR model was established by clamping (ischemia) and releasing (reperfusion) the abdominal aorta at the supraceliac level for 20 min. All rats were given 3 ml/kg of distilled water by gavage for 14 days before and 7 days after the experiment. The treatment groups received either melatonin (50 mg/kg) or spirulina (50 mg/kg) by the same route. On the 21st day of the experiment, the rats were sacrificed. We found that melatonin and spirulina ameliorated the effects of IR at different levels of significance (ranging from p = .01 to p < .001), increasing total antioxidant capacity (TAC) and superoxide dismutase levels, and decreasing total oxidant status, oxidative stress index (OSI), myeloperoxidase, tumor necrosis factor-alfa and malondialdehyde levels. When compared MIR and SIR groups, only TAC and OSI levels did differ in favor of melatonin between the groups (p < .05). Histopathological and immunohistochemical examinations showed that melatonin and spirulina similarly reduced IR-related tissue damage and apoptosis. We concluded that melatonin and spirulina may have a protective role against oxidative tissue damage and apoptosis in the abdominal aortic IR animal model. PRACTICAL APPLICATIONS: Coarctation of aorta (CoA) and interrupted aortic arch (IAA) are serious cardiac defects with high morbidity and mortality if not diagnosed and treated early in life. Restoration of blood flow in CoA or IAA through prostaglandin E1 infusion, angioplasty or surgery can cause ischemia/reperfusion (IR) injury. This reperfusion period may be complicated IR injury at remote organs. It may be beneficial to increase antioxidant capacity in preventing stress-induced tissue damage. Melatonin and spirulina are agents with strong antioxidant properties. In this animal research, protective role of these products on multiorgan damage induced by IR was investigated for the first time. We found that both melatonin and spirulina ameliorate the effects of IR to varying degrees. This study provides evidence that melatonin and spirulina may have preventive effects on oxidative tissue damage and apoptosis in the abdominal aortic IR animal model.

Funnel technique for wide infrarenal aneurysm neck with Lifetech Ankura™ Stent Graft System.

BACKGROUND: In this study, we present our mid-term results in patients undergoing treatment with the funnel technique and describe technical issues for this bailout technique in extra-wide infrarenal necks. METHODS: Between January 2018 and June 2020, a total of seven male, symptomatic patients (median: 74.5 years; range, 64 to 84 years) who had comorbidities and were in the American Society for Anesthesiologists Class IV and treated by the funnel technique in an endovascular fashion were included. Pre- and post-procedural data of the patients, early mortality and technical success rates were evaluated. RESULTS: There was no early mortality. Technical success rate was 100%. There was no type I or III endoleaks at the completion angiography. All patients were discharged without any problem on the second or third day of the procedure. The median follow-up was 13 (range, 6 to 28) months. The aneurysm sac shrinkage was achieved in all patients over six months of follow up. During the follow-up period, no proximal endoleak or infrarenal aortic neck diameter enlargement was found. CONCLUSION: Based on our limited experience, the funnel technique may be considered more than a bailout procedure under special circumstances.

Outcomes after EVAR in females are similar to males.

INTRODUCTION: Women are less likely to develop infrarenal abdominal aortic aneurysm; however, when they do, it is almost always associated with challenging anatomy, more rapid aneurysmal growth rate and earlier rupture. Women generally have poorer outcomes following open aneurysm repair; and in this respect, the present study aims to evaluate if it is so after endovascular repair. METHODS: A retrospective analysis of our database was performed for patients underwent endovascular aneurysm repair (EVAR) between January 2013-March 2020. 249 elective EVAR patients were evaluated. Patients were categorized according to gender and 26 patients (10.4%) were female. Demographics and pre-peri-postoperative findings were compared. Propensity score matching (ratio 1:1) was performed to reduce selection bias. RESULTS: In the overall unmatched cohort, female population had more diabetes mellitus (p = 0.016) and hypertension (p = 0.005). However, coronary artery disease (p = 0.005) and coronary artery bypass grafting (p = 0.006) were more in male gender. Non-IFU implantation was higher in female group (38.5% vs. 11.5%, p = 0.025). After propensity matching, even though it was not statistically significant, early mortality for female gender was higher when compared to male gender (7.7% and 0%, respectively, p = 0.490). In the follow-up period, no difference in all-cause mortality, secondary interventions or complications have been observed between the genders. CONCLUSION: Challenging anatomy and subsequently treated patients outside IFU may be the reasons for higher morbidity and mortality in women. However, despite these factors female and male patients revealed equivalent early and late results.

Changes in intraocular pressure during coronary artery bypass graft surgery: an observational study.

BACKGROUND: In this study, the effects of pulsatile and non-pulsatile on-pump Coronary Artery Bypass Graft surgery (CABG) and off-pump CABG techniques on the intraocular pressure were investigated. METHODS: Forty-five patients who planned to elective coronary artery bypass surgery with on-pump pulsatile (n=15), non-pulsatile (n=15), or off-pump (n=15) were included. Intraocular Pressure (IOP) measurements were performed on both eyes at nine time-points: 1) Before the operation, 2) After anesthesia induction, 3) 3 minutes after heparin administration Left Internal Mammary Artery (LIMA) harvesting, 4) End of the first anastomosis, 5) End of LIMA anastomosis, 6) 3 minutes after protamine administration, 7) End of the operation, and 8) Second hour in Intensive Care Unit (ICU), 9) Fifth hour in ICU. Mean Arterial Pressure (MAP) and Central Venous Pressure (CVP) were also recorded at the same time points as IOP. RESULTS: In Cardiopulmonary Bypass (CPB) groups (pulsatile or non-pulsatile CPB) with the beginning of CPB, there were significant decreases in IOP values when compared to baseline (p=0.012). This decrease was more prominent in the non-pulsatile group when compared to the pulsatile group (T4 IOP values: pulsatile, 9.7±2.6; non-pulsatile, 6.8±1.9; p=0.002; T5 IOP values: pulsatile, 9.5±1.9; non-pulsatile, 6.7±2.1; p=0.004). At the end of the surgery (T7), IOP values returned to the baseline and stayed stable at the remaining time-points. In-off pump group, IOP values significantly increased with a head-down position (T4 IOP values: off-pump surgery, 19.7±5.2; p=0.015). IOP values remained high until the normalization of head-down position (T6) and stayed stable through the rest of all remaining time-points. CONCLUSION: During cardiac surgery regardless of the technique (on-pump CABG, off-pump CABG), intraocular pressures remain in the normal ranges. It should be kept in mind that patients should be avoided from long and extreme Trendelenburg position, low CVP, and MAP levels during cardiac surgery to prevent eye-related complications.

Subclinical Hypothyroidism Increases the Requirement of Renal Replacement Therapy After Cardiac Surgery.

BACKGROUND: Subclinical or biochemically diagnosed hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels. Thyroid hormones play a major role in the normal function of the heart and vascular physiology. Atherosclerosis, increased systemic vascular resistance, and decreased arterial compliance are common pathophysiological changes that may occur in hypothyroidism. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, diabetes mellitus (DM), preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of SCH on AKI and the requirement of renal replacement therapy (RRT) after isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively reviewed the prospectively collected data of 336 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL) from January 2017 to January 2019. The patients were divided into two groups either having the diagnosis of SCH (Group I, N = 47) or not (Group II, N = 289). SCH was diagnosed based on preoperative serum TSH and FT4 levels. Kidney injury was interpreted, according to RIFLE classification. The effect of SCH on AKI and the need for RRT after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. RESULTS: Subclinical hypothyroidism was diagnosed in 14% of all patients. Postoperative AKI occurred in 15 patients (31.9%) in Group I, whereas there were 42 patients (14.5%) in Group II. On logistic regression analysis, the presence of SCH was shown to be associated with an increased incidence of postoperative AKI (OR, 0.363; 95% CI, 0.181-0.727; P = .004). RRT was used in 2.97% of patients (seven patients in Group I and three patients in Group II, P < .001). The 30-day mortality was 2.1%. CONCLUSION: The presence of SCH seems to be associated with an increased incidence of AKI and increased requirement for RRT after cardiac surgery.

Preoperative Vitamin D Level is Associated with Postoperative Delirium After Cardiac Surgery in Patients Over 65 Years of Age.

INTRODUCTION: Delirium after cardiac surgery is a devastating and important complication. Delirium is defined as "disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)." In this study, we analyzed the association of preoperative vitamin D levels and postoperative delirium after cardiac surgery in patients over 65 years. MATERIALS AND METHODS: We retrospectively reviewed the data of 212 adult patients above 65 years of age who underwent isolated coronary artery bypass graft surgery from January 2016 to January 2018. The mean age for Group I was 69.7 ± 7.4 and Group II was 70.6 ± 4.8 years. There were 112 female patients in Group I and 46 female patients in Group II. The patient population was divided into 2 groups based on preoperative serum vitamin D (25-hydroxyvitamin D [25-OHD]) levels (normal range of 25-75nmol/L). Group I included patients with preoperative serum 25-OHD level<25nmol/L. Group II included patients with preoperative serum 25-OHD level ≥25nmol/L. RESULTS: The incidence of delirium in this study was 30.2%. In this study, 138 patients (65.1%) had preoperative serum 25-OHD levels <25 nmol/L, and 74 patients (34.9%) had preoperative serum 25-OHD levels ≥25 nmol/L. Preoperative serum 25-OHD levels were associated with postoperative delirium after coronary artery bypass graft surgery. Our retrospective study illustrated that a lower preoperative serum level of 25-OHD was associated with postoperative delirium. Our results showed that 65.1% of patients had preoperative serum 25-OHD levels <25 nmol/L, and this was associated with postoperative delirium. CONCLUSION: Vitamin D deficiency exacerbates delirium after coronary artery bypass surgery with cardiopulmonary bypass. Whether the effects of vitamin D deficiency during this event represent separate or interrelated activities with cardiopulmonary bypass is an important question to address and prospective randomized studies are necessary to confirm these results.

Effect of Iloprost, a Prostacyclin Analogue, on Myocardial Ischemia-Reperfusion Injury

Myocardial ischemia-reperfusion injury continues to be observed during open heart surgery. Various experimental models have been developed to overcome this injury and to increase postoperative prognosis. This study was conducted to assess the effect that iloprost, a prostacyclin analogue, can have on myocardial ischemia-reperfusion injury. We evaluated tissue damage by measuring the levels of malonyldialdehyde (MDA), glutathione, and nitric oxide (NO) in tissue and perfusates. In this study, 20 guinea pig hearts were prepared by using the modified Langendorff perfusion apparatus to form control (n = 10) and experimental study groups (n = 10). Following a preischemic period of perfusion and an ischemic period of 20 minutes, control hearts were perfused with Krebs­Henseleit solution. In the experimental group, iloprost (0.45 µg/kg per hour) was included in the perfusates for the last 10 minutes of the preischemic phase. Following cardiac stabilization, heart rate (pulse/min), contractility (mm), and aortic pressure (mmHg) values were recorded at the end of preischemia, postischemia, and reperfusion. Perfusate and tissue analyses for glutathione, MDA, and NO levels were made in each group at the end of experiments. Iloprost was found to have protective effects against myocardial ischemia by means of increased myocardial contractility, decreased tissue/perfusate glutathione levels and inhibited rise of tissue/perfusate MDA observed in the iloprost-treated experimental group. Future investigations on myocardial ischemia-reperfusion injury must evaluate iloprost-related mechanisms.

Preoperative Urinary pH is Associated with Acute Kidney Injury After Cardiac Surgery in Non-Diabetic Patients.

BACKGROUND: Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The present study aims to analyze the association of preoperative urinary pH with acute kidney injury after isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively reviewed the data of 270 adult non-diabetic patients who underwent isolated CABG surgery with normal renal function. The perioperative data of the patients included demographic data, laboratory findings, morbidity, and mortality. The patient population was divided into four groups: Group I, patients with preoperative urinary pH=5; Group II, patients with preoperative urinary pH=5.5; Group III, patients with preoperative urinary pH=6-6.5; and Group IV, patients with preoperative urinary pH ≥ 7.0. Kidney injury was interpreted according to the Kidney Disease: Improving Global Outcomes (KDIGO). RESULTS: There were 108 patients (40%) in Group I, 44 patients (16.3%) in Group II, 78 patients (28.9%) in Group III, and 40 patients (14.8%) in Group IV. Postoperative acute kidney injury (AKI) occurred in 39 patients (36.1%) in Group I, 4 patients (9.1%) in Group II, and 2 patients (2,5%) in Group III. None of the patients developed AKI in Group IV. Renal replacement therapy was required in 8 patients (2.3%) (6 patients from Group I; 2 patients from Group II; P = .016). Thirty-day mortality occurred in 5 patients (1.9%) (5 patients from Group I; none from other groups; P =  .017). All of the patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower pH levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 0.193; 95% CI: 0.103-0.361; P < .001). CONCLUSION: Low preoperative urinary pH (≤5.5) results in severe acute kidney injury and increases the rate of morbidity and mortality after isolated CABG.

Saphenous vein wrapping for the treatment of a perigraft seroma: report of a case.

A 61-year-old man who had undergone an iliofemoral bypass with an expanded polytetrafluoroethylene (PTFE) graft was readmitted to our hospital for the investigation and treatment of a possible complication of the surgery. A tender, pulsatile, bulging mass, about the size of an adult fist, was palpated around the left lower abdominal region. Diagnostic procedures showed a large low-density area around the PTFE graft and angiography revealed a patent graft with no anastomotic leakage. An operative inspection revealed the mass to be a large perigraft seroma. The PTFE graft was covered with a saphenous vein strip, a treatment that has not previously been mentioned in the literature. The success of this strategy was confirmed by clinical observations and diagnostic procedures including ultrasonography and computed tomography, with no sign of recurrence for 5 months.

Inferior vena cava aneurysm with hemothorax: rare presentation.

We presented a case of hemothorax secondary to inferior vena cava (IVC) aneurysm. A 47-year-old woman was presented to our hospital with nausea, vomiting, and right superior abdominal pain. There was pleural effusion on the right side of the posteroanterior chest x-ray for which a thoracentesis was performed and serohemorrhagic fluid was determined. Biochemical tests showed a mixed transudate and hemorrhage (hemothorax). Cytology was negative for malignancy. Computed tomography revealed a right-sided pleural effusion and a suprahepatic mass that was neighboring IVC and right atrium. Suprahepatic IVC aneurysm without venous obstruction was shown by magnetic resonance imaging and angiography. Mass was explored with right thoracotomy through sixth intercostal space, and the aneurysmal mass was seen and dissected from neighboring tissues. The mass was discrete and directly related to IVC just above the right hepatic vein entrance. After the excision of the aneurysm, the IVC wall was repaired. Histopathologic examination confirmed our diagnosis as venous aneurysm. The patient was discharged without any complication on the sixth postoperative day.