The alterations of retinal vasculature detected on optical coherence tomography angiography associated with chronic obstructive pulmonary disease.

OBJECTIVES: This study aimed to evaluate the retinal vasculature of the macula and optic disc in patients with chronic obstructive pulmonary disease (COPD) by optical coherence tomography angiography (OCTA). METHODS: The right eyes of 70 COPD patients and 71 healthy individuals were evaluated. These patients had moderate airflow limitation and mean PO2 of 60 mmHg, and their average age was less than 60 years. Superficial and deep capillary plexus vascular densities, foveal avascular zone (FAZ) width, and optic disc parameters were measured with OCTA. In addition, the correlation between the PO2 level in COPD patients and superficial, deep, and peripapillary vascular densities and FAZ was examined in the study. RESULTS: The COPD group had a significant decrease in the vascular density in the superficial (fovea [p = 0.019]; parafovea [p = 0.013]; and perifovea [p = 0.001]) and deep capillary plexus (fovea [p = 0.028]; parafovea [p = 0.005]; and perifovea [p = 0.002]). Also, the enlargement of the FAZ (p = 0.002) and a decrease in the peripapillary vascular density (p = 0.006) were observed in the COPD group. There was a positive correlation between PO2 level and superficial, deep, and peripapillary vascular densities in COPD patients and a negative correlation with FAZ (r = 0.559-0.900). CONCLUSION: Hypercapnia, respiratory acidosis, and chronic hypoxia associated with COPD may affect the macula and optic nerve, resulting in a serious decrease in vascular density, and OCTA can be a very important tool in the follow-up and treatment of these patients.

Evaluation of corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome.

PURPOSE: In the present study we evaluate the corneal endothelium using specular microscopy in patients with obstructive sleep apnea syndrome (OSAS). METHODS: The study included a total of 100 patients including 35 patients with mild OSAS, 34 patients with moderate OSAS and 31 patients with severe OSAS, and the right eyes of 30 patients as a control group. Patients were examined to exclude the possibility of ocular diseases. Cellular density in the cornea epithelium (cell/mm2), corneal thickness (µ), percentage of hexagonal cells (%) and the coefficient of variation were evaluated using a specular microscope. RESULTS: Corneal thickness was significantly decreased in all OSAS groups when compared to the control group (p = 0.002), while no significant difference was identified among the OSAS groups. The corneal endothelial cell density, percentage of hexagonal cells and coefficient of variation were significantly different between the OSAS groups and the control group (p < 0.001). CONCLUSION: More significant impairments were noted in the corneal endothelium of the patients in the OSAS group than in the control group, and specular microscopy is in valuable in the follow-up and treatment of such patients.

Evaluation of the Usefulness of YouTube Videos on Retinal Detachment Surgery.

Introduction The aim of this study is to evaluate the usefulness of YouTube videos about retinal detachment surgery as a resource. Methods The first 100 videos were evaluated when they were scanned by typing "retinal detachment surgery " in the YouTube search engine. These videos were also analyzed and scored using DISCERN, Journal of the American Medical Association (JAMA), and Global Quality (GQ) scoring systems. Results The DISCERN score of the evaluated videos was 39.5±8.4; JAMA score was 1.9±0.5; and the GQ score was 2.1±0.5. According to the results, retinal detachment surgery videos, DISCERN score is medium; The JAMA score was evaluated as low quality and poor quality in the GQ score. Conclusion Although there are enough videos on YouTube with retinal detachment surgery, its usefulness as a resource is low, and its quality is poor.

Is ocular vascularity affected in young migraine patients? A pilot study.

OBJECTIVE: This study aimed to evaluate ocular vascularity in young adult migraine patients with visual aura and without visual aura. MATERIAL AND METHODS: The study included 30 patients with migraine with visual aura (MWVA), 30 patients with migraine without visual aura (MWOVA), and 30 healthy control subjects, all between ages ≥18 and <45. Migraine patients were applied Headache Impact Test (HIT) and Migraine Disability Assessment Scale (MIDAS). Retinal nerve fiber layer thickness and ocular vascularity of all participants were evaluated with optical coherence tomography (OCT) and OCT angiography (OCTA). RESULTS: The MWVA group had significantly lower superficial and deep foveal vascular density values compared to the control group (p = 0.039, p = 0.028, respectively). The foveal avascular zone was significantly enlarged in the MWVA group compared to the control group (p = 0.033). MWVA patients had significantly lower whole optic disc, optic disc inside, peripapillary, superior hemisphere, inferior hemisphere, superior quadrant, and temporal quadrant vascular density values compared to the control group (p < 0.05 all), while there was no significant difference in the nasal quadrant (p = 0.083). Migraine attack frequency, MIDAS, and HIT were negatively correlated with ocular vascular density values. CONCLUSION: The results of our study indicate that young adult patients with MWVA are at risk of decreased ocular vascularity and that this risk may increase with frequency and severity of migraine attacks.

Evaluation of the corneal endothelium by specular microscopy in patients with chronic obstructive pulmonary disease.

OBJECTIVE: The objective of this study is to evaluate the corneal endothelium in patients with chronic obstructive pulmonary disease (COPD) using a specular microscope. METHODS: The right eyes of 64 patients with a COPD diagnosis and 65 healthy individuals were evaluated. Cell density (CD) (cell/mm2 ), corneal thickness (CT) (µ), hexagonal cell ratio (%), and coefficient of variation (cell area standard deviation/mean cell area, µm2 ) were analyzed by specular microscopy (SM). RESULTS: The CT was significantly reduced in the COPD group compared with the control group (P = 0.021). Moreover, a significant difference was found between the COPD group and the control group in terms of corneal endothelial CD (P = 0.011), hexagonal cell ratio (P = 0.008), and coefficient of variation (P = 0.012). CONCLUSION: The corneal endothelial structure was significantly deteriorated in patients with COPD compared with the control group. SM is a valuable method that could be used in treatment and follow-up of corneal endothelium in patients with COPD.

Evaluation of Retinal Changes in Varicocele Patients With Optical Coherence Tomography Angiography.

OBJECTIVE: To evaluate the macula and optic disc in varicocele patients with optical coherence tomography angiography (OCTA). METHODS: The right eyes of 30 patients with varicocele and 30 healthy volunteers were evaluated. Superficial and deep capillary plexus vascular densities, foveal avascular zone (FAZ) width, and optic disc parameters were measured with OCTA. RESULTS: There was a significant decrease in vascular density in the superficial and deep capillary plexus in the varicocele group compared to the control group, but no difference was found in FAZ and optic disc parameters. CONCLUSION: Patients with varicocele have reduced microvascular density in the retina; therefore, it may be beneficial to perform a detailed eye examination with OCTA in these patients.

A comparative study on the effects of flexible and rigid laryngoscopy techniques on intraocular pressure.

OBJECTIVES: This study compared the impact of transoral rigid laryngoscopy (TORL) and transnasal flexible laryngoscopy (TNFL) methods on intraocular pressure (IOP). METHODS: This study included 100 patients, with 50 patients undergoing a TORL, and 50 patients a TNFL. Before procedure IOP values were recorded by an ophthalmologist using Icare Pro tonometry, also immediately post procedure, and at the 15th, 30th and 60th minute after laryngoscopy. RESULTS: Both groups were similar in terms of age, gender, mean body mass index (BMI), and pre-laryngoscopy IOP values. When the TNFL and TORL groups were compared, no significant differences were observed between pre-laryngoscopy, and 60th minute IOP values (p = 0.891, p = 0.149, respectively). IOP values measured immediately after laryngoscopy, and at the 15th and 30th minute were significantly higher in the TORL group (p < 0.001, p < 0.001, p = 0.002, respectively). CONCLUSIONS: We demonstrated higher IOP fluctuations in the TORL group, when compared to the TNFL group. For this reason, TNFL may be considered a safer method for evaluating laryngeal tissues in conditions that require lower IOP fluctuation as in glaucoma. However, further studies are required to clarify the exact effects of IOP fluctuations during TNFL and TORL in patients with glaucoma.

Effect of Deviated Nasal Septum on Choriodal Thickness.

INTRODUCTION: Nasal septal deviation (NSD) is one of the major causes of upper airway obstruction. Chronic hypoxia and hypercapnia due to NSD may affect the choroidal blood flow and may change the choroidal thickness (CT). In this study, the authors aimed to research the assessment of CT before and after septoplasty in patients with NSD. METHODS: Ninety-two patients who underwent septoplasty surgery with the diagnose of nasal septum deviation and 58 patients for control group were enrolled to the study. CT values measured before and three months after septoplasty surgery. RESULTS: CT values were subfoveal 272.51 ±â€Š27.62, nasal 245.50 ±â€Š21.22, temporal 248.35 ±â€Š30.25 and subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82,temporal 227.12 ±â€Š28.80 for the control and NSD groups, respectively (P < 0.001). Also choroid thickness values (subfoveal 232.09 ±â€Š44.17, nasal 222.09 ±â€Š38.82, temporal 227.12 ±â€Š28.80; subfoveal 252 ±â€Š18.90, nasal 228 ±â€Š22.12, temporal 240 ±â€Š25.80) were significantly different in patients with NSD, before and after septoplasty procedure, respectively (P < 0.001). CONCLUSION: To the authors' knowledge this is the first study investigating choroid thickness measurements before and after septoplasty in patients with NSD. We found significant correlation between NSD and CT. After septoplasty surgery at 3rd month, CT increased significantly in comparision with the preoperative values.

Comparison of three posterior malleolar fixation methods in trimalleolar ankle fractures.

This study aimed to compare the results of AP screws, PA screws and posterior buttress plate used in posterior malleolar fixation of trimalleolar fractures. In this study, the data of 104 trimalleolar fracture cases treated surgically between October 2011 and January 2014 were extracted from hospital records. Patient demographics (age, gender, body mass index), the presence of syndesmotic injury, fracture type (according to the Lauge-Hansen classification), the size of posterior malleolar fragment (measured on lateral radiographs) were recorded. The patients requiring postoperative care for at least a year were invited to attend an evaluation of functional and radiological outcomes. At the final follow-up examination the functional evaluation was made by using AOFAS scores, VAS scores during walking, and dorsiflexion restrictions as compared with the unaffected side. As for the radiological evaluation, the patients were assessed according to the presence of a gap or step by the direct use of graphies following the fixation and with regard to the osteoarthritic development in alignment with the Bargon criteria. A total of 67 patients met the study inclusion criteria; 20 cases in the AP screw, 13 cases in the PA screw and 34 cases in the plate group. The mean follow-up period was 14.4 ± 2.23 months in AP, 16.3 ± 2.56 months in PA and 17.1 ± 3.01 months in the plate group. Better AOFAS scores were obtained in the PA group and the plate group compared to the AP screw group (p < 0.001). No statistically significant difference was found between the groups in respect of VAS scores during walking and dorsiflexion restriction. Better radiological reduction was observed in the PA screw group and the plate group (p < 0.001).

Association of preoperative plasma fibrinogen level with postoperative bleeding after on-pump coronary bypass surgery: does plasma fibrinogen level affect the amount of postoperative bleeding?

OBJECTIVES: Our primary aim was to investigate the association between the preoperative concentration of plasma fibrinogen and the volume of postoperative bleeding. Our secondary aim was to identify whether there is a possible correlation between the patients' different characteristics and haemostatic laboratory variables and the postoperative amount of bleeding after on-pump coronary artery bypass grafting procedures. METHODS: A total of 550 adult patients undergoing isolated coronary artery bypass grafting on cardiopulmonary bypass in our hospital were enrolled and investigated retrospectively. The total amount of chest tube drainage within the first 24 postoperative hours or until the patient was re-explored for bleeding was assessed. Excessive bleeding was defined as more than 500 ml drainage in the first 24 h. The patients were divided into 2 groups: Group 1: the patients who bled ≤500 ml in the first 24 h and Group 2: the patients who bled >500 ml in the first 24 h. RESULTS: A preoperative fibrinogen threshold associated with excessive bleeding was investigated by receiver operating characteristic curve analyses, revealing a calculated cutoff value of 3.1 g/l. Risk factors for increased bleeding were analysed by a logistic regression model that revealed male gender (P < 0.001), body mass index ≤28.3 kg/m2 (P < 0.001), platelet count ≤233 × 103/µl (P < 0.001), estimated glomerular filtration rate ≤90.8 ml/min (P < 0.001) and fibrinogen ≤3.1 g/l (P = 0.01) as significant predictors. CONCLUSIONS: A preoperative plasma fibrinogen concentration <3.1 g/l was associated with increased risk of excessive bleeding in patients undergoing on-pump coronary artery bypass grafting. The amount of postoperative blood loss can be roughly predicted with simple preoperative blood tests.

A comparison of the effects of platelet-rich plasma and demineralized bone matrix on critical bone defects: An experimental study on rats.

BACKGROUND: Delayed union of fractured bone is one of the main problems of orthopedics and traumatology practice. It was hypothesized that the beneficial effects of allogeneic platelet-rich plasma (PRP) would be valuable in the treatment of segmental bone defects. This study is a comparison of the effects of demineralized bone matrix (DBM) and PRP in a segmental bone defect model. METHODS: Total of 48 Wistar albino rats were separated into 4 groups. Segmental bone defect was created at right radius diaphysis in all specimens using dorsal approach. Four additional rats were used as PRP source. Intracardiac blood was withdrawn before the operation for preparation of allogeneic PRP. Group 1 (n=12) served as control group and defects were left untreated. Group 2 (n=12), was PRP group, and received grafting with PRP. Group 3 (n=12) was PRP+DBM combination group, and was treated with grafting and mixture of DBM and PRP. In Group 4 (n=12), defect area was grafted with DBM only. At the end of 10th week, rats were sacrificed, forearms were dissected, and defect areas were examined with radiological and histopathological parameters. RESULTS: Radiological evaluation revealed that ossification was best in PRP group, followed by DBM group. According to results of histopathological studies, union quality was better than control group in all treatment groups (Groups 2, 3, and 4), and was best in PRP group (p<0.05). Results were also better in PRP group when examined in terms of cortex development and remodeling (p<0.05). When examined in terms of new osteogenesis, results were comparable in Groups 2, 3, and 4, but all were better than control group. CONCLUSION: It was concluded that PRP and DBM have comparable effect on recovery of defective bones, but there is no synergistic effect when used together. We believe that PRP can be a cost-effective, readily available alternative to DBM with minimal morbidity.

Evaluation of plantar pressure distributions in patients with anteriorcruciate ligament deficiency: preoperative and postoperative changes.

BACKGROUND/AIM: Anterior cruciate ligament (ACL) deficiency results in several kinematic changes in the lower extremities. The aim of this study is to define the plantar pressure parameters in ACL-deficient patients and to show the effect of ACL reconstruction on dynamic plantar pressure. MATERIALS AND METHODS: Forty patients with unilateral ACL rupture and 40 healthy controls were included in this study. Dynamic plantar pressures of both groups were recorded by the EMED SF-2 system during level walking. Thirteen of the patients who had ACL reconstructions with hamstring autografts (HS group) were reevaluated at an average of 14.5 months following the ACL reconstructions. RESULTS: ACL-deficient patients had significantly lower hindfoot (P = 0.007) but higher midfoot pressure values (P = 0.03) on their ipsilateral foot compared to control group subjects. Ipsilateral hindfoot pressures were also found to be significantly lower than those of the contralateral foot (P = 0.001). Hindfoot pressure values of the HS group were increased in postoperative measurements (P = 0.01). CONCLUSION: ACL-deficient patients have altered plantar pressure distributions and ACL reconstructions restore these changes to normal. Pedobarography might be used as a practical method for dynamic functional assessment of ACL-deficient patients.

Gluteal compartment syndrome secondary to superior gluteal artery injury following pelvis fracture: A case report and review of literature.

Acute gluteal artery syndrome secondary to superior gluteal artery injury following pelvic fracture is a rare entity with potential for significant morbidity and mortality. In this report we present such a case resulting with a favorable outcome with prompt diagnosis and appropriate treatment.

Traction table versus manual traction in the intramedullary nailing of unstable intertrochanteric fractures: A prospective randomized trial.

INTRODUCTION: The purpose of this prospective randomized study was to compare traction table with manual traction for the reduction and nailing of unstable intertrochanteric femur fractures. DESIGN: Prospective, randomized, two-center trial. MATERIALS AND METHODS: 72 elderly patients with AO/OTA 31A2 and 31A3 proximal femur fractures were randomized to undergo surgery with either manual traction (MT) or traction table (TT) facilitated intramedullary nailing. The demographics and fracture characteristics, duration of preparation and surgery, total anaesthesia time, fluoroscopy time, blood loss, number of assistants, early post-operative radiological evaluations and 6th month functional and radiological outcomes were evaluated. Data of 64 patients attending 6th month follow-up examination were evaluated statistically. RESULTS: No significant differences were observed between groups regarding demographics and fracture characteristics. In the manual traction group, there was a significant time gain in respect of the positioning and preparation period (18.0±1.6min in MT group, 29.0±2.4min in TT group) (p<0.05). In terms of total anaesthesia time (Preparation+surgery) approximately 6min of difference was observed in favor of MT group (72.8±14.0min for MT and 78.6±6.5min for TT, [p<0.05]). Median number of assistants needed was significantly lower in TT group (2 assistants [1-3]) in MT group and (1 assistant [1,2]) in TT group [p<0.05]). There was no significant difference between two groups regarding other surgical and outcome parameters. CONCLUSIONS: Manual traction reduced the preparation time and total anaesthesia duration, despite an increase in number of surgical assistant. LEVEL OF EVIDENCE: Level II.

Role of anti-adhesive barriers following rotator cuff repair surgery: an experimental study.

OBJECTIVE: This experimental study investigates the effectiveness of expanded polytetrafluoroethylene (Dualmesh®, Gore Medical, Flagstaff, AZ, USA), sodium hyaluronate-carboxymethyl cellulose (Seprafilm®, Genzyme, Cambridge, MA, USA), and polysiloxane (silicone) as anti-adhesive barriers for inhibition of fibrosis in the subacromial area following rotator cuff repair. METHODS: Rabbit rotator cuff tenotomy and repair was conducted on 24 rabbits in 4 groups: control (Group A), Dualmesh® (Group B), Seprafilm® (Group C), and silicone (Group D). Anti-adhesive barrier materials were sutured over the repaired rotator cuff. Macroscopic and histological evaluations were made at the end of the sixth postoperative week. RESULTS: Macroscopic evaluation revealed that minimal adhesion occurred in the control and silicone groups, while the Seprafilm® and Dualmesh® groups showed evidence of fibrosis. Microscopic evaluation revealed diffuse fibrosis and collagen accumulation in the Dualmesh® and Seprafilm® groups, whereas minimal collagen deposition and inflammatory cell reaction was found among the silicone and control groups. Significant differences were found between the silicone and Dualmesh® (p=0.001) and silicone and Seprafilm® groups (p=0.002), as well as between the control and Dualmesh® (p=0.002) and control and Seprafilm® groups (p=0.002). CONCLUSION: Expanded polytetrafluoroethylene (ePTFE/Dualmesh®) and sodium hyaluronate carboxymethyl cellulose (SH-CMC/Seprafilm®) did not prevent or attenuate postoperative subacromial fibrosis following cuff tear repair. Nor did silicone prevent or attenuate fibrosis. More detailed research is needed for development of an effective anti-adhesive barrier for use after rotator cuff tear surgery.

Does really previous stenting affect graft patency following CABG? A 5-year follow-up: The effect of PCI on graft survival.

The aim of this study was to compare the graft patency rates among patients who had a previous history of percutaneous coronary intervention (PCI) followed by coronary artery bypass grafting surgery (CABG) with the patients who had experienced CABG surgery alone. The 69 patients who were included in the study had a history of bare metal stent implantation prior to CABG (group 1). The coronary angiography results were compared with 69 patients who had a previous history of CABG (group 2). Graft patency rates of the left anterior descending artery and circumflex anastomoses are statistically significant for both groups, whereas the right coronary artery anastomoses are not statistically significant (p = 0.008; 0.009; 0.2). Graft patency rate of LIMA-LAD anastomoses was 43.9 ± 10.8 % in group 1 and 86.2 ± 6 % in group 2 for means of 60 months (p = 0.0001) and circumflex coronary artery anastomosis is 28.9 ± 0.9 % in group 1, 65.7 ± 10.8 % in group 2 (p = 0.0001) and the right coronary artery anastomosis is 37.2 ± 13.6 % in group 1, 56.4 ± 8.9 % in group 2 (p = 0.0001). The graft patency rates of coronary arteries without previous stent implantation were higher than the patients with previous stent implantation and experienced CABG. The results suggest that prior PCI may induce atherosclerotic events in the vessel that can adversely affect graft patency after surgery.

Effect of intramuscular botulinum toxin-A in a rat rotator cuff repair model: an experimental study.

OBJECTIVE: Rotator cuff repair is associated with multiple complications, significant morbidity, and reintervention, which could be mitigated by postoperative chemodeneveration with botulinum toxin-A (BTX-A). This study evaluated the antinociceptive and paralytic effects of BTX-A on an experimental supraspinatus repair rat model and its effect on functional outcomes (running performance). METHODS: Thirty rats were grouped into the surgical repair group (group A), repair + intramuscular BTX-A group (group B), or control group (group C). At the end of the 3-month follow-up, running performance of the rats on a motorized treadmill was evaluated in four time periods (0-30 min, 30-60 min, 60-90 min, and 90-110 min), and penalty points (i.e., number of shock stimuli per lane) were recorded. Afterwards, the supraspinatus muscles were removed and evaluated histologically. RESULTS: Regarding running performance, group B received significantly fewer penalty points than did group A (p<0.05). The penalty points received were not significantly different between groups B and C in the first three time periods, but were significantly higher in group B at the 90-110-min interval than in group C. On necropsy, all repaired tendons were intact, with no sign of failure at the repair site. Histological evaluation revealed marked degeneration and necrosis of muscles in both repair groups, which was much less evident in group B. Groups A and B had less fatty infiltration than group C. CONCLUSION: BTX-A injections resulted in a better function based on running performance, probably due to decreased tissue tension at the repair site and less pain. Further studies on humans are needed to demonstrate this effect clinically.

The effect of equine-derived bone protein extract (Colloss-E) in the treatment of cavitary bone defects: an experimental study.

OBJECTIVE: Bone protein extract (BPE) usually requires a carrier or a scaffold for implantation. We aimed to compare the effect of equine-derived BPE, an osteoinductive agent composed of a high amount of type-I collagen and other bone proteins (Colloss-E), with that of human demineralized bone matrix (DBM) for treating cavitary bone defects not requiring scaffold use. METHODS: Rabbit distal femoral condyle was used as a stable cavitary bone defect model. Bone defects of 6-mm diameter and 10-12-mm depth were created in the femoral condyles. Rabbits were assigned into the equine-derived BPE (BPE), human-derived DBM (DBM), and control (C) groups. Approximately 20 mg of BPE was implanted into the defect in the equine-derived BPE group (n=6), whereas 0.3 cc of DBM was implanted in the DBM group (n=6). Defects were left empty in the C group (n=6). The defect area was histologically examined after 6 weeks. RESULTS: There were no instances of macroscopic defect collapse or failure. Histopathological examination revealed that the BPE group had better scores (statistically significant) than both the other groups in terms of quality of union. The BPE group also had higher scores than the DBM group in terms of graft incorporation and new-bone formation. CONCLUSION: The current study revealed results consistent with those of the previous studies concerning BPEs. Equine-derived BPE was found to be successful for treating cavitary bone defects not requiring scaffold use.

Coronary artery bypass grafting in the octogenarians: should we intervene, or leave them be?

OBJECTIVE: Coronary artery bypass grafting (CABG) is gradually increasing in the elderly population. We aimed to investigate the risk factors and the results of CABG along with the long term survival in patients at an age of 80 and older. METHODS: Between January 2002 and December 2011, a total of 101 consecutive patients at an age of 80 and older who underwent CABG in our hospital were included in the study. The patients were followed and the long-term survival was estimated. RESULTS: The mean age of the patients was 82.98 ± 2.27 years. Sixty-four (63.4%) were males and 37 (36.6%) were females. Emergency surgery, duration of cardiopulmonary bypass, the intensive care unit (ICU) stay, inotropic support, intra aortic balloon pulsation application, amount of erythrocyte transfusion and fresh frozen plasma transfusion and ventilation period were significantly higher in the patients who died in the hospital. The duration of cardiopulmonary bypass (CPB) was found to be an independent predictor of mortality (OR: 1.18, 95% CI 1.01-1.38, P = 0.034). The in-hospital mortality was 16.8%. Kaplan-Meier analyses revealed a survival ratio of 91.3% at one year, 82.9% at three years and 69.0% at five years. CONCLUSIONS: Patients at the age of 80 and older can be candidates for the CABG procedure bearing in mind that they may have a longer ventilation period and intensive care unit stay. The morbidity and mortality of this age group is considered within an acceptable range. Approaches to minimize CPB, or the choice of off-pump surgery, may be a preventive method to lower the incidence of mortality. Hence, CABG may be performed in this age group with a satisfactory survival ratio.