Tissue Factor and Vascular Endothelial Growth Factor in Detecting Thromboembolic Complications in Diabetic Atherosclerotic Patients.

Background: Atherosclerosis, which is one of the leading causes of death all over the world, can create major or minor thromboembolic complications with the exponentially increasing diabetic status. Despite all the studies, the mechanism by which endothelial damage in atherosclerosis is triggered in diabetic setting is still not fully understood. Methods: In this study, tissue factor (TF), which is thought to act together in the formation of vasular endothelial growth factor (VEGF-A) and coagulopathy in diabetic atherosclerotic patients, may be an important indicator in this regard, a total of 100 cases who were undergone off-pump coronary artery bypass (OPCAB) which were at same risk group examined by dividing into diabetic status. Early postoperative process and biochemical parameters analyzed in terms of TF and VEGF-A levels measured before and after the operation. Results: TF and VEGF-A expression of the T1DM group were statistically high compared to non-diabetics. Significantly longer hospital stays with changes in TF and VEGF-A were found in patients in the diabetic group compared to pre- and postoperatively, respectively; TF (95% CI: 0.879-0.992; p = 0.025), VEGF-A (95% CI: 0.964-0.991; p = 0.001) and hospital stay (95% CI: 1.96-7.49; p = 0.0001). Preoperatively measured carotid intima-media thickness (CT) was higher in diabetics and was significantly associated with atrial fibrillation (AF), (r = 0.873). Surgical team and protocols were same and OPCAB procedures were routinely applied to all patients in our clinic. No minor or major events were observed in any of the cases. Conclusion: TF and VEGF-A values in patients with diabetic atherosclerosis may be important in the early detection of thromboembolic complications.

Epidural anesthesia versus general anesthesia in patients undergoing minimally invasive direct coronary artery bypass surgery.

OBJECTIVE: Minimally invasive direct coronary artery bypass (MIDCAB) surgery in the awake patient with epidural anesthesia had been previously reported. However, there is no prospective randomized study comparing MIDCAB surgery with epidural anesthesia versus general anesthesia. METHODS: The study was conducted as a prospective and randomized study. Between January 2002 and May 2003, 76 patients were randomly assigned into either MIDCAB under general anesthesia (GA Group) or MIDCAB under epidural anesthesia (EA Group). The EA Group patients did not receive concomitant general anesthesia and they were conscious throughout the procedure. All patients had a left internal thoracic artery to left anterior descending coronary artery bypass using the same MIDCAB techniques. There were 42 patients in the GA Group and 34 patients in the EA Group. For statistical analysis, unpaired t-test for independent samples was used for comparison of continuous variables, and Pearson Chi-Square test was used for comparison of discrete variables. RESULTS: The demographic characteristics of the groups were similar. There was no mortality or major morbidity in both groups. The EA Group patients had lower arterial oxygen saturations (93.3+/- 3.2% versus 97.4+/- 1.3%, p<0.001) and higher partial carbon dioxide pressures (45.8+/- 3.6 mmHg versus 41.5+/- 2.5 mmHg, p<0.001), but these were not clinically significant. The EA Group patients had significantly less intensive care unit (ICU) (5.5+/- 6.5 hours versus 18.2+/- 4.8 hours, p<0.001) and hospital stay periods (31.4+/- 20.7 hours versus 58.6+/- 17.9 hours, p<0.001), as well as significantly less postoperative pain (visual analog score 1.06+/-0.6 versus 2.3+/-0.6, p<0.001) and blood loss (184.2+/- 169.0 ml versus 371.7+/- 315.3 ml, p<0.001). There was no any difference in regard to patient satisfaction after the procedure between the two groups. Long -term results were equally satisfactory in both groups. CONCLUSION: It can be concluded that, similar surgical results can be achieved by MIDCAB surgery with general or epidural anesthesia. Although epidural anesthesia has no impact on the degree of patient satisfaction after the procedure, it yields significantly shorter ICU and hospital stay periods, which may result in more efficient use of hospital resources.

Facile stabilization and exposure techniques in off-pump coronary bypass surgery.

Off-pump coronary artery bypass grafting can not be performed without adequate stabilization and exposure techniques. Although most of the commercially available systems provide effective stabilization and exposure, their use were generally deemed time consuming and cumbersome. Achieving the same and even better results with simple traction sutures has led to the abandonment of commercially available systems. Although not a primary concern, the radial suture traction technique is also extremely cost efficient.

Frequency of left atrial myxoma with concomitant coronary artery disease.

PURPOSE: Simultaneous coronary artery bypass grafting with a resection of left atrial myxoma has been rarely reported. The ages and the symptoms of patients who have left atrial myxomas and coronary artery disease are similar. In this report, we present our cases of left atrial myxoma with concomitant coronary artery disease who were all treated surgically. METHODS: Between September 1998 and January 2001, 11 patients were surgically treated after being diagnosed to have left atrial myxoma. Routine coronary angiography was performed on all patients preoperatively. In four patients concomitant coronary artery disease was identified. At surgery we performed coronary artery bypass grafting after a resection of left atrial myxoma in three patients. RESULTS: All patients were weaned from cardiopulmonary bypass without any difficulty. The postoperative course was uneventful. The follow-up period was 17 +/- 10 months (range 3-32 months). All patients were symptom-free and no recurrence of myxoma was detected. CONCLUSION: Based on our experience, cardiovascular surgeons should be aware of the concomitance of these diseases. It is therefore recommended that coronary angiography should be performed on all patients who present with left atrial myxomas.

Coronary-coronary bypass using vein graft on a beating heart in a patient with porcelain aorta.

There is increased risk of systemic embolism during cardiopulmonary bypass in patients with a severely atherosclerotic ascending aorta. We report a coronary-coronary bypass in a 74-year-old man with a porcelain aorta. He underwent a proximal right coronary-distal right coronary artery bypass with a saphenous vein graft, combined with a pedicled arterial graft (left internal mammary artery) to the left anterior descending artery, in the presence of a beating heart without cardiopulmonary bypass. The patient survived without evidence of perioperative myocardial infarction or cerebrovascular accident. One year later, follow-up angiography showed graft patency with good distal run-off. Coronary-coronary bypass on a beating heart without cardiopulmonary bypass can be performed safely in a patient with porcelain aorta.