Salvage of brachiocephalic aneurysmatic fistulas, using ePTFE graft with a minimally invasive approach.

BACKGROUND: In this study, we evaluated our surgical approach in requiring surgical treatment of brachiocephalic arteriovenous fistula (AVF) aneurysms for salvage of AVF. METHODS: Between 2012 and 2022, 20 patients (16 men, 4 women; mean age 54.5 years) who were surgically treated for a brachiocephalic AVF aneurysm in our Cardiovascular Surgery Clinic were evaluated retrospectively. These 20 patients were operated on for aneurysm thrombosis and fistula failure in 16 patients, sudden rupture and severe bleeding in 3 patients, cosmetic reasons, and anxiety in 1 patient. RESULTS: These aneurysms were ligated and divided from distal and proximal cephalic veins. Then, a 6 mm dialysis graft was interposed between the well-developed cephalic vein distal and proximal to the aneurysm with small skin incisions. All patients were taken to dialysis via this dialysis graft 24 h after the procedure without any problem. All patients were discharged after dialysis. After surgery, no catheterization or any other additional procedure was required for hemodialysis. No complications, such as infection, hematoma, neurological damage, or ischemia, were observed after the surgical procedure. The mean postoperative follow-up was 12 months. CONCLUSION: In brachiocephalic AVF aneurysms requiring surgical treatment, hemodialysis can be continued with a graft placed in the same arm in this technique.

[Left ventricular mass regression after aortic valve replacement]. / Aort kapak replasmani sonrasi sol ventrikül kütle gerilemesi.

OBJECTIVE: Our objective was to evaluate the degree of change in left ventricular mass index (LVMI) regression after aortic valve replacement (AVR) using three different valves. METHODS: Group 1 (n=17) included patients with bioprosthesis (Medtronic Hancock 2), Group 2 (n=21) included patients with mono-leaflet mechanical valve (Medtronic Hall), and Group 3 (n=17) included patients with bi-leaflet mechanical valve (St Jude). The mean ages of Group 1, 2 and 3 patients were 70.8±9.1, 61.6±13.7 and 56.2±18.3 years, respectively. In this observational study, patients were followed-up after surgery and left ventricular wall thickness and valvular functions were evaluated with echocardiography. The findings were compared with preoperative values. Statistical analyses were performed using one-way variance analysis (ANOVA), Kruskal -Wallis, and Chi-square tests. RESULTS: Statistically significant difference was observed among the three groups with respect to age (p=0.015). LVMI regressed in all groups; Group 1 from 232.74±53.36 g/m² (preoperative) to 174.64±46.33 g/m² (postoperative) (p=0.0001), Group 2-from 198.49±40.53 g/m2 to 167.04±33.9 g/m² (p=0.0001), and Group 3-228.77±47.87 g/m² to 185.44±37.76 g/m² (p=0.0001). No statistically significant difference was observed among the groups with respect to LVMI regression (p=0.054, p=0.363). CONCLUSION: Mid-term results of AVR with three different aortic valve prosthesis revealed that all groups showed a similar regression of left ventricular mass. However, we advocate that long-term results of an increased number of patients should be evaluated for assessment in depth.

Combination of right atrial and left ventricular myxoma.

Myxomas are common cardiac tumors that are managed by complete excision. The combination of a right atrial and left ventricular myxoma is very rare. We discuss a patient with right atrial and left ventricular myxoma who underwent successful surgical excision of both myxomas. There was no clinical or echocardiographic recurrence or valvular insufficiency at the 6-month follow-up.

Posterior root enlargement for aortic valve replacement associated with unexpected anomalous right coronary artery.

Anomalous right coronary artery (ARCA) generally follows a course between the aorta and pulmonary artery. When ARCA follows a course posterolateral to the aortic root behind the noncoronary sinus of Valsalva, the vessel can be at risk of injury during posterior aortic root enlargement. We present the case of a 21-year-old man with congenital aortic stenosis and small aortic root, who had an intraoperative diagnosis of ARCA. After posterior root enlargement through the noncoronary sinus, ARCA was mobilized from the aortic root and reimplanted into the right coronary sinus. Postoperative follow-up of the patient was uneventful.

Right coronary revascularization by coronary-coronary bypass with a segment of internal thoracic artery.

In certain coronary artery bypass grafting operations, the internal thoracic artery is not by itself adequate for complete arterial revascularization. Which graft should be used for revascularization of the right coronary artery is still a matter of debate. From August 2000 through July 2005, we performed coronary-coronary bypass grafting on 48 patients (77.1% men, 22.9% women), whose mean age was 57.2 years (range, 40-75 yr). After completion of the internal thoracic artery anastomoses, we performed coronary-coronary bypass grafting with a remaining (distal) segment of the left (or, rarely, the full length of the free right) internal thoracic artery. The proximal and distal anastomoses of the internal thoracic artery to the right coronary artery were end-to-side. We preferred to use the right coronary ostium as the proximal anastomosis site where possible; otherwise, we used a disease-free segment of the right coronary artery. A total of 192 anastomoses were performed (mean, 4.15 per patient); all used the bilateral internal thoracic arteries as conduits. There were no in-hospital deaths or perioperative myocardial infarctions. The duration of follow-up ranged from 1 to 46 months (mean, 9.6 mo). Follow-up angiography was performed in 24 patients (50%). The mean time to coronary angiography was 16.5 months (range, 7 days-2 years). The patency rate was 100%. We conclude that coronary-coronary anastomosis by means of a distal segment of the internal thoracic artery can help to achieve complete arterial revascularization in selected patients.

Video-assisted bilateral epicardial pulmonary vein isolation for the treatment of lone atrial fibrillation.

BACKGROUND: This paper aims to evaluate the feasibility and the efficacy of a new off-pump, bilateral thoracoscopic pulmonary vein isolation technique in patients with lone atrial fibrillation. METHODS: Between April 2004 and February 2006, 26 drug-resistant and symptomatic lone atrial fibrillation patients (18 permanent, 8 paroxysmal) underwent an irrigated radiofrequency ablation procedure using the Cardioblate ablation system (Medtronic, Minnesota). There were 16 men and 10 women with a mean age of 55 +/- 11 years. Mean duration of atrial fibrillation was 34.2 +/- 18.9 months. All patients underwent a bilateral thoracoscopic procedure in which both pulmonary veins were ablated with an atrial cuff using an off-pump epicardial approach. The conduction block was assessed by pacing the pulmonary veins after each ablation. Sixteen patients underwent endoscopic stapling of the left atrial appendage. RESULTS: There were no hospital deaths. All procedures were completed as planned without any conversions to sternotomy. There were no major complications. Follow-up was complete at 6 months, and 80% of the patients were in sinus rhythm (paroxysmal: 100%, permanent: 72%). Of the patients with permanent atrial fibrillation, 85% had regained their atrial transport function. No major thromboembolic event was observed during the follow-up period. CONCLUSIONS: The video-assisted bilateral pulmonary vein isolation technique was safe and effective. It was curative for paroxysmal atrial fibrillation patients and effective for permanent atrial fibrillation cases. This technique may find wider application if accumulating data further support these findings.