The Feasibility and Early Results of Multivessel Minimally Invasive Coronary Artery Bypass Grafting for All Comers.

OBJECTIVES: Cardiovascular surgery advancements have emerged with various minimally invasive approaches for treating multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. We present our clinical experience and minimally invasive coronary bypass techniques through minithoracotomy, which we apply without selection to patients who have decided to have elective surgery for multivessel isolated coronary artery disease. METHODS: It consists of 230 consecutive patients operated by the same team with this method between July 2020 and September 2022. The patients were assigned to one of the two methods preoperatively to their accompanying comorbidities and operated on either with blood cardioplegia via 5 to 7 cm left anterior minithoracotomy, with on-pump clamped technique or without pump via left anterolateral minithoracotomy. RESULTS: Mortality was observed in two of our patients (0.9%), but myocardial infarction was not observed in our patients in the early postoperative period. None of our patients required conversion to sternotomy (0%). Five patients' needed reoperation from the same incision due to postoperative bleeding (2.2%), and atrial fibrillation developed in 17 patients in the postoperative period (7.4%). The mean number of bypasses was found to be 3.0 ± 0.9. CONCLUSIONS: Minimally invasive coronary artery bypass surgery via minithoracotomy can be routinely reproduced safely. More long-term results and more multicenter studies are needed for more widespread acceptance of the technique.

Relationship Between Work Mode, Time of Admission, and Mortality in St-Segment Elevation Myocardial Infarction: Results From the TURKMI Registry.

Treatment of acute myocardial infarction has evolved steadily. However, limited studies exist regarding the effect of all innovations on mortality. We aimed to investigate the effect of time of admission and work mode on 1-year outcomes in patients presenting with ST-segment elevation myocardial infarction (STEMI). Based on the TURKMI registry, we analyzed 735 STEMI patients recruited consecutively and prospectively from 50 PCI-capable cardiology clinics within a prespecified two-week period. Centers were categorized as "on-call" and "on-duty" according to their work mode. At 1-year follow-up, all-cause mortality and cardiovascular mortality were the primary outcomes. The secondary outcome was a composite of coronary revascularization, re-infarction/stroke, and recurrent angina. One-fifth of the participants (19.5%) were treated in the on-call group. All-cause mortality (7.9 vs 10.5%, aHR: 1.16, P = .650) and cardiovascular mortality rates (6.1 vs 9.1%, aHR: 1.35, P = .413) were similar between centers' modes of work. Likewise, both groups were equally likely to undergo coronary revascularization (P = .278), re-MI/stroke (P = .280), recurrent angina (P = .175), and the composite outcome of these components (P = .482). No significant difference was observed in primary outcomes between weekend and weekday admissions. In conclusion, we observed similar outcomes between the on-call and on-duty groups among STEMI patients.

Clinical Presentation and Outcomes in Real-Life Management of Elderly Patients Aged ≥75 Years Presenting with Acute Myocardial Infarction.

BACKGROUND: The aim of this study was to provide insight into the real-life clinical presentation and outcomes of the elderly presenting with acute myocardial infarction from the Turkish Myocardial Infarction registry database. METHODS: TURKMI was a nationwide, multicenter, observational, 15-day snapshot registry conducted to address the management of acute myocardial infarction patients admitted to percutaneous intervention-capable hospitals. The present analysis included the comparison of consecutively enrolled acute myocardial infarction patients aged ≥75 and <75 years. RESULTS: Of the overall 1930 patients, 362 patients were aged ≥75 years. Elderly patients were more likely to have hypertension and renal failure and less likely to have hypercholesterolemia. Elderly patients were admitted to hospitals almost 1 hour later mainly due to a late call to emergency medical service. At discharge, medical therapies were significantly less prescribed to the elderly. The proportion of patients undergoing coronary angiography was significantly lower in elderly (81.8% vs. 96.4%, P < .001). Both in-hospital and 1-year mortality were significantly higher in elderly patients (9.1% vs. 2.7% and 22.7% vs. 5.8%, P < .001 respectively). The adjusted risk of 1-year mortality was 4-fold in elderly (hazard ratio and 95% CI 4.0 [2.9-5.6], P < .001). In multivariate analysis, every 5-beat/min increase in heart rate increased mortality by 7%. Higher heart rate and use of antiplatelet agents on admission were predictors of mortality in elderly. CONCLUSION: In real-life settings, elderly patients presenting with acute myocardial infarction are prone to prolonged total ischemic time and are subjected to less-intensive medical treatment and interventional approaches. Besides age, the increased heart rate could be the major determinant of mortality.

Time delays in each step from symptom onset to treatment in acute myocardial infarction: Results from a nation-wide TURKMI registry.

OBJECTIVE: In this study, we aimed to analyze the TURKMI registry to identify the factors associated with delays from symptom onset to treatment that would be the focus of improvement efforts in patients with acute myocardial infarction (AMI) in Turkey. METHODS: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of 24/7 primary percutaneous coronary intervention (PCI). All consecutive patients (n=1930) with AMI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018, and November 16, 2018. All the patients were examined in detail with regard to the time elapsed at each step from symptom onset to initiation of treatment, including door-to-balloon time (D2B) and total ischemic time (TIT). RESULTS: After excluding patients who suffered an AMI within the hospital (2.6%), the analysis was conducted for 1879 patients. Most of the patients (49.5%) arrived by self-transport, 11.8% by emergency medical service (EMS) ambulance, and 38.6% were transferred from another EMS without PCI capability. The median time delay from symptom-onset to EMS call was 52.5 (15-180) min and from EMS call to EMS arrival 15 (10-20) min. In ST-segment elevation myocardial infarction (STEMI), the median D2B time was 36.5 (25-63) min, and median TIT was 195 (115-330) min. TIT was significantly prolonged from 151 (90-285) min to 250 (165-372) min in patients transferred from non-PCI centers. The major significant factors associated with time delay were patient-related delay and the mode of hospital arrival, both in STEMI and non-STEMI. CONCLUSION: The baseline evaluation of the TURKMI study revealed that an important proportion of patients presenting with AMI within 48 hours of symptom onset reach the PCI treatment center later than the time proposed in the guidelines, and the use of EMS for admission to hospital is extremely low in Turkey. Patient-related factors and the mode of hospital admission were the major factors associated with the time delay to treatment.

Short and Midterm Outcomes in Patients With Acute Myocardial Infarction: Results of the Nationwide TURKMI Registry.

This recent Turkish Myocardial Infarction registry reported that guidelines are largely implemented in patients with acute myocardial infarction (MI) in Turkey. We aimed to obtain up-to-date information for short- and midterm outcomes of acute MI. Fifty centers were selected using probability sampling, and all consecutive patients with acute MI admitted to these centers (between November 1 and 16, 2018) were enrolled. Among 1930 (mean age 62 ± 13 years, 26% female) patients, 1195 (62%) had non-ST segment elevation myocardial infarction (NSTEMI) and 735 (38%) had ST segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) was performed in 94.4% of patients with STEMI and 60.2% of those with NSTEMI. Periprocedural mortality occurred in 4 (0.3%) patients. In-hospital mortality was significantly higher in STEMI than in patients with NSTEMI (5.4% vs 2.9%, respectively; P = .006). However, the risk became slightly higher in the NSTEMI group at 1 year. Women with STEMI had a significantly higher in-hospital mortality compared with men (11.2% vs 3.8%; P < .001); this persisted at follow-up. In conclusion, PCI is performed in Turkey with a low risk of complications in patients with acute MI. Compared with a previous registry, in-hospital mortality decreased by 50% within 20 years; however, the risk remains too high for women with STEMI.

Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study.

OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1). METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).

Baseline clinical characteristics and patient profile of the TURKMI registry: Results of a nation-wide acute myocardial infarction registry in Turkey.

OBJECTIVE: The TURKMI registry is designed to provide insight into the characteristics, management from symptom onset to hospital discharge, and outcome of patients with acute myocardial infarction (MI) in Turkey. We report the baseline and clinical characteristics of the TURKMI population. METHODS: The TURKMI study is a nation-wide registry that was conducted in 50 centers capable of percutaneous coronary intervention selected from each EuroStat NUTS region in Turkey according to population sampling weight, prioritized by the number of hospitals in each region. All consecutive patients with acute MI admitted to coronary care units within 48 hours of symptom onset were prospectively enrolled during a predefined 2-week period between November 1, 2018 and November 16, 2018. RESULTS: A total of 1930 consecutive patients (mean age, 62.0±13.2 years; 26.1% female) with a diagnosis of acute MI were prospectively enrolled. More than half of the patients were diagnosed with non-ST elevation MI (61.9%), and 38.1% were diagnosed with ST elevation MI. Coronary angiography was performed in 93.7% and, percutaneous coronary intervention was performed in 73.2% of the study population. Fibrinolytic therapy was administered to 13 patients (0.018%). Aspirin was prescribed in 99.3% of the patients, and 94% were on dual antiplatelet therapy at the time of discharge. Beta blockers were prescribed in 85.0%, anti-lipid drugs in 96.3%, angiotensin converting enzyme inhibitors in 58.4%, and angiotensin receptor blockers in 7.9%. Comparison with European countries revealed that TURKMI patients experienced MI at younger ages compared with patients in France, Switzerland, and the United Kingdom. The most prevalent risk factors in the TURKMI population were hypercholesterolemia (60.2%), hypertension (49.5%), smoking (48.8%), and diabetes (37.9%). CONCLUSION: The nation-wide TURKMI registry revealed that hypercholesterolemia, hypertension, and smoking were the most prevalent risk factors. TURKMI patients were younger compared with patients in European Countries. The TURKMI registry also confirmed that current treatment guidelines are largely adopted into clinical cardiology practice in Turkey in terms of antiplatelet, anti-ischemic, and anti-lipid therapy.

Rationale and design of the Turkish acute myocardial infarction registry: The TURKMI Study.

OBJECTIVE: To the best of our knowledge, there is no up-to-date information regarding the presentation, management, and clinical course of patients with acute myocardial infarction (MI) in Turkey. The TURKMI registry is designed to provide an insight into the characteristics, management from the symptoms onset to the hospital discharge, and outcome of patients with acute MI in Turkey. METHODS: The TURKMI study, as a nationwide registry, will be conducted in 50 percutaneous coronary intervention-capable centers, selected from each EuroStat NUTS region in Turkey according to their population sampling weight, prioritizing the hospital volume in each region. All consecutive patients with acute MI admitted to the coronary care units within the 48 hours of the symptoms onset will be prospectively enrolled during a predefined 2-week period. The first step of the study has a cross-sectional design in which baseline information such as symptoms, risk factors, time periods at each step from the symptoms onset to revascularization, way of arrival to hospital, biochemical analysis, and in-hospital management and outcome will be assessed. The second step has a cohort characteristic in which the enrolled patients will be followed-up up to 2 years. Follow-up visits will be conducted at the 1st, 6th, 12th, and 24th month, and predictors and risk of cardiovascular events and implementation of guidelines will be assessed as secondary outcomes. CONCLUSION: The national TURKMI registry is expected to provide important information to improve the national policy regarding diagnosing, management, and outcomes of MI in Turkey.

[Bradyarrhythmias and pacemaker indications in elderly patients]. / Yasli hastalarda bradiaritmiler ve pacemaker endikasyonlari.

With the dramatic increase in the number of elderly people in most parts of the world and in our country there will be an accompanying increase in patients with sinus node dysfunction (SND) and atrioventricular (AV) block. For this reason, it will be essential for health care personnel to have a basic knowledge of bradyarrhythmias and the special considerations required for managing these rhythms in elderly patients. Because of frailty of this patient group indivualised approach and consideration for management of these patients must be done carefully. Decision for permanent pacemaker therapy and pacemaker mode selection should be done according to the underlying pathology and patient characteristics.

Corrected balloon occlusive diameter to determine device size during percutaneous atrial septal defect closure.

OBJECTIVE: The aim of this trial was to investigate the impact of corrected balloon occlusive diameter (cBOD) on successful performance of percutaneous atrial septal defect (ASD) closure. METHODS: The trial comprised 86 patients (60 female, 26 male; mean age 36.5±14.3) on whom percutaneous ASD closure was performed. Patients were evaluated using transesophageal echocardiography (TEE). Relation of the defect to surrounding tissues and size of rims was also investigated. Balloon sizing was performed intraoperatively on all patients. Size of device was ascertained according to both durability of rims and whether or not they formed significant indentation, both of which determine cBOD. RESULTS: The ASD closure device was successfully implanted in 84 (97.5%) patients. Mean maximum defect size was 17.4±5.9 mm, and mean color flow diameter was 16.8±5.4 mm. Mean maximum defect size at the moment of loss of shunt flow was 18.4±5.9 mm with TEE, and 18.8±6.1 mm with fluoroscopy. Mean size of Amplatzer occluder device was 20.0±6.5 mm. Device embolization was observed in 2 patients. However, no death occurred during or after the procedure. CONCLUSION: Percutaneous secundum ASD closure is a safe and effective treatment modality in experienced centers. Utilizing corrected balloon occlusive diameter may be of benefit in deciding the size of ASD occluder device.

Effect of percutaneous mitral balloon valvuloplasty on right ventricular functions in mitral stenosis: short- and mid-term results.

OBJECTIVE: To evaluate the short- and mid-term effects of percutaneous mitral balloon valvuloplasty (PMBV) on right ventricular functions in mitral stenosis. METHODS: A prospective study was conducted in 61 patients who had mitral stenosis in normal sinus rhythm (68% female, age: 42±11-16 years). Right ventricular functions were measured before, immediately after, and at 3 months and 1 year after PMBV by conventional and tissue Doppler echocardiography imaging methods. Additionally, the patients were evaluated in two groups (PAP≥40 mm Hg, n: 46; PAP<40 mm Hg, n: 15) according to the systolic pulmonary artery that was measured by echocardiography prior to PMBV. RESULTS: Post-PMBV mean gradient, pulmonary artery pressure (PAP), and left atrial size decreased significantly, and the mitral valve area increased significantly in both patient groups. This significance in pulmonary artery pressure was lost at 1 year. The significant post-PMBV increase in tricuspid annular point systolic excursion (TAPSE), systolic velocity, early diastolic velocity, and peak myocardial velocity during isovolumic contraction (IVV), indicating right ventricular functions, disappeared at 1 year. The significant post-PMBV decrease in myocardial performance index (MPI) and late diastolic velocity lost its significance at 1 year. No significant change was observed in myocardial acceleration during isovolumic contraction (IVA). The group with pulmonary hypertension demonstrated significance similar to the results of the overall group. Post-PMBV TAPSE, systolic velocity, early diastolic velocity, IVV, and IVA increased significantly, and this increase was maintained up to 1 year in the group without pulmonary hypertension. MPI and late diastolic velocity maintained their significantly decreased values up to 1 year. CONCLUSION: The positive effect of PMBV on right ventricular function in the acute period decreases and even disappears in the mid-term in patients developing pulmonary hypertension. Intervention in the patients prior to the development of hypertension is very important for the improvement in right ventricular functions.

The effects of successful percutaneous mitral balloon valvuloplasty on acute and intermediate term aortic stiffness.

AIM: The aim of this study was to evaluate the effects of percutaneous mitral balloon valvuloplasty (PMBV) on short- and intermediate-term aortic stiffness in patients with mitral stenosis. MATERIALS AND METHODS: This prospective study included 56 patients with critical mitral stenosis in normal sinus rhythm (68% female; mean age: 42 ± 11 years) and 37 healthy controls. Aortic stiffness was measured using transthoracic echocardiography before PMBV, and 24-48 hours and 1 year post procedure. RESULTS: Aortic strain and distensibility were significantly higher in the patients with mitral stenosis, both after PMBV and 1 year post procedure, whereas the aortic stiffness index (ASI) was significantly lower. There was also a significant decrease in mitral mean gradient (MMG) and systolic pulmonary artery pressure (sPAP) after PMBV, based on echocardiography and catheterization. Mitral valve area (MVA) significantly increased after PMBV. There was a significant correlation between change in ∆MVA and ∆MMG and aortic elastic properties. There was a significantly negative correlation between the ∆MVA and ∆∆ aortic stiffness (r = -0.62, P < 0.001), and a significantly positive correlation between ∆MMG and ∆ASI (r = 0.60, P < 0.001). CONCLUSION: Mitral valve stenosis was associated with impaired aortic stiffness and following PMBV, aortic stiffness decreased during both the acute period and the intermediate period.

Early- and mid-term effects of percutaneous mitral balloon valvuloplasty on left atrial mechanical functions in mitral stenosis.

OBJECTIVES: The aim of the study was to evaluate left atrial (LA) mechanical functions in MS before and after percutaneous mitral balloon valvuloplasty (PMBV) and to follow it up in short- and mid-term. STUDY DESIGN: We carried out a prospective study of 49 patients with critical mitral stenosis (MS) who had normal sinus rhythm. LA mechanical functions were evaluated before and 24-48 h, 3 months, and 1 year after PMBV, which included LA passive emptying volume (LAPEV), LA active emptying volume (LAAEV), LA total emptying volume (LATEV), LA passive emptying fraction (LAPEF), LA active emptying fraction (LAAEF), LA total emptying fraction (LATEF), and conduit volume. RESULTS: The transthoracic echocardiography parameters of the MS patients before and 24-48 h, 3 months, and 1 year after PMBV were as follows: (a) mitral valve area 1.1 cm² (0.9-1.6); 2.2 cm² (1.8-2.8) (p<0.001); 2.2 cm² (1.7-2.9) (NS); 2.1 cm² (1.8-2.7) (p<0.001); (b) LAPEV 13 ml/m² (9-27); 11 ml/m² (8-19) (p<0.001); 10 ml/m² (7-19) (p<0.001); 10 ml/m² (6-18) (p<0.001); (c) LATEV 26 ml/m² (19-50); 21 ml/m² (16-40) (p<0.001); 20 ml/m² (15-36) (p<0.001); 19 ml/m² (15-34) (p<0.001); (d) Conduit volume 30 ml/m² (22-44); 33 ml/m² (26-46) (p<0.001); 34 ml/m² (30-42) (p<0.001); 36 ml/m² (31-42) (p<0.001), respectively. However, LAAEV, LAPEF, LAAEF, and LATEF were not altered after PMBV. CONCLUSION: The findings of this study demonstrated an improvement of LA mechanical functions, which continued to improve for 1 year, after successful treatment of MS by PMBV.

Evaluation of the effect of mitral stenosis severity on the left ventricular systolic function using isovolumic myocardial acceleration.

BACKGROUND: Isovolumic acceleration (IVA) is a new tissue Doppler parameter in the assessment of systolic function of both left and right ventricles. It remains unaffected with the changes in pre- and after-load within the physiological range. The aim of our study was to assess the effect of mitral stenosis degree, which is determined by echocardiography, on the left ventricular (LV) function using IVA. METHODS: A total number of 62 patients with mitral stenosis (MS) and 32 healthy controls were examined. The severity of MS (mild, moderate, and severe) was determined on the basis of mitral valve area (MVA) and the mean diastolic mitral gradient findings. The peak myocardial velocities during isovolumic contraction, systole, early diastole and late diastole were measured by using tissue Doppler imaging (TDI). RESULTS: All TDI-derived global LV basal wall systolic (peak myocardial isovolumic contraction velocity, peak myocardial systolic velocity and IVA), and diastolic velocities (peak early and late diastolic velocities) were significantly decreased in the patients with MS, compared to the healthy patients (p < 0.001, for all). However, IVA was not different when the degree of MS was evaluated (p = 0.114). In addition, IVA was not correlated with the MVA (r = 0.185, p = 0.150). CONCLUSIONS: Left ventricular function is impaired in patients with MS regardless of the severity of the disease.

Hematologic and clinical parameters after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis.

BACKGROUND: Previous studies have demonstrated that platelet activation occurs in patients with aortic stenosis (AS). This study sought to evaluate the changes in hematologic and clinical parameters noted with the improvement in AS following transcatheter aortic valve implantation (TAVI) in patients with severe AS at high risk of surgery. PATIENTS AND METHODS: The study included 33 patients who underwent TAVI. In addition to biochemical, clinical, and echocardiographic examinations, hematologic blood parameters were recorded before TAVI, at discharge, and at 1 and 4 months. RESULTS: Mean platelet volume (MPV) showed a progressive decrease after TAVI. On echocardiography at 1 month, aortic valve area significantly increased, with significant decreases in peak and mean gradients. Progressive decreases were also noted in N-terminal proB-type natriuretic peptide levels. CONCLUSION: Our findings show that TAVI improves hemodynamic parameters of the valve with marked clinical and echocardiographic improvement, resulting in decreased platelet activation and MPV in patients with severe AS.

Aspirin resistance in patients with impaired renal functions.

BACKGROUND: Cardiovascular diseases (CVD) are the leading cause of death in patients with chronic kidney diseases (CKD). Aspirin resistance (AR) worsens prognosis in CVD. AIM: The aim of this study was to detect AR prevalence in this patient group. METHODS: The 203 patients (mean age 61.84 ± 11.51 years, 128 [63.1%] male) with stable coronary artery disease included in the study were grouped into four study groups according to their estimated glomerular filtration rate (eGFR) values. Multiplate test was used to determine AR. Platelet aggregation results were presented as aggregation unit (AU) × min and values over 300 AU × min were accepted as AR. RESULTS: 61 (30.04%) patients in the whole study population were found to have AR. Differences were detected between AR ratios and multiplate values of the patient groups (p = 0.006 and p = 0.002). AR ratio was highest in patient group 4 (eGFR < 30 mL/min/1.73 m²) and/or on chronic haemodialysis therapy, whereas there was little difference among the other three groups. In multivariate analysis, while AR status was independently related to female sex (OR = 2.31,CI 1.14-4.65, p = 0.019) and mean platelet volume (MPV) (OR = 1.68, CI 1.21-2.33, p = 0.002), multiplate test results were independently related to MPV (b = 0.265, p < 0.0001) and eGFR (b = -0.165, p = 0.025). CONCLUSIONS: The AR ratio was found to be high in severe CKD patients, especially haemodialysis patients, but not in mild and moderate CKD patients. This increased AR ratio in severe CKD patients may affect the prognosis in patients who already have an increased risk for cardiovascular complications.

Electrophysiological evaluation of atrioventricular conduction disturbances in transcatheter aortic valve implantation with Edwards SAPIEN prosthesis.

AIMS: Permanent pacemaker requirement is a known complication after transcatheter aortic valve implantation (TAVI). The aim of the present study was to analyze the effects of Edwards SAPIEN prosthesis implantation on atrioventricular conduction. METHODS: The study included 28 patients who underwent TAVI due to severe aortic valve stenosis. An electrophysiological study was performed in the catheterization room immediately before the initial balloon valvuloplasty and immediately after Edwards SAPIEN prosthesis implantation. RESULTS: His-ventricle interval was significantly prolonged postprocedure (55.9 ± 11.5 ms) vs preprocedure (47.3 ± 7.8 ms) (P<.001). The antegrade Wenckebach point was observed to be significantly prolonged postprocedure (354.4 ± 41.3 ms) vs preprocedure (333.7 ± 45.4 ms) (P=.001). Despite atrial-His interval prolongation, it was not statistically significant. After the procedure, we observed significant conduction disturbances in 3 patients (10.7%). These conduction problems recovered before discharge. One of the patients (3.6%) with right bundle branch block + left anterior fascicular block required permanent pacemaker implantation. At postprocedure electrocardiogram, QRS duration increased, QRS axis shifted to the left, and both of the values became normal before discharge. The patient's echocardiographic and clinical parameters were improved during follow-up. CONCLUSION: The effect of Edwards SAPIEN on the conduction system was mostly infranodal and temporary. The physical properties of the Edwards SAPIEN prosthesis may explain this observation. This complication may be lessened if the frame height characteristics can be improved.

Evaluation of atrial electromechanic delay and left atrial mechanical functions in the patients with secundum type atrial septal defect.

AIM: The aim of our study was to evaluate atrial electromechanical delay (AEMD) and left atrial mechanical functions (LAMF) in the patients with secundum-type atrial septal defect (ASD). METHOD: We included 72 patients with secundum type ASD in the study group and 35 gender and age-matched healthy volunteers for the control group. Maximal, minimal, and presystolic LA volumes were measured by modified Simpson method and indexed to the body surface area (BSA). Inter-AEMD, right and left intra-AEMD were measured from the lateral and septal mitral annulus and tricuspid annulus using tissue Doppler imaging (TDI). RESULTS: The age, gender, systolic and diastolic blood pressure, heart rate (HR), BSA, and body mass index (BMI) parameters were not significantly different between the groups. Left atrial active and total emptying fractions and conduit volumes were significantly lower in the patients with ASD compared with the control group (P = 0.006, P = 0.001, and P = 0.032, respectively). Total emptying volume was increased in patients with ASD (P = 0.021). Passive emptying volume and fraction and active emptying volumes were not different significantly between the groups (P > 0.05). The left intraatrial, right intraatrial, and inter-AEMDs were significantly longer in the ASD group (P = 0.032, P = 0.013, and P = 0.003, respectively). CONCLUSION: The left atrial reservoir and contractile pump functions are reduced; the left intraatrial, right intraatrial, and inter-AEMDs are increased in the patients with ASD.

Ventricular embolization of Edwards SAPIEN prosthesis following transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) is an alternative therapy in patients with severe aortic stenosis (AS) and high surgical risk. Despite continuous improvements in operators' expertise and device technology, complications associated with TAVI are common. We present a case in which an Edwards SAPIEN prosthetic valve dislocated to the left ventricular outflow tract with hemodynamic collapse 4 hours following implantation and embolized into the left ventricle (LV) during resuscitation.

[Heart failure prevalence and predictors in Turkey: HAPPY study]. / Türkiye'deki kalp yetersizligi prevalansi ve öngördürücüleri: HAPPY çalismasi

OBJECTIVES: The aim of this study was to determine the prevalence of heart failure (HF) in adult residents of Turkey based on echocardiography and N-terminal B type natriuretic factor. STUDY DESIGN: 4650 randomly selected residents aged ≥ 35 years were enrolled. Height, weight, waist and hip circumference, and blood pressure measurements were taken, and a 12-lead ECG was performed. Advanced age, hypertension (HT), diabetes mellitus (DM), obesity, and chronic renal failure (CRF) were assessed. History of any heart disease, any abnormal ECG, or an NT-proBNP ≥ 120 pg/mL was accepted as echocardiography indication. Patients with systolic and/or diastolic dysfunction, or NT-proBNP ≥ 2000 pg/mL were classified as having HF if their functional capacity was NYHA ≥ Class II, and were classified as having asymptomatic left ventricular dysfunction (ASVD) if their functional capacity was NYHA