Bacterial Load Associated With Tunneled Dialysis Catheters in Symptom-Free Hemodialysis Patients.

OBJECTIVE: This study aimed to evaluate the rate of asymptomatic bacterial infection of tunneled dialysis catheters (TDCs) removed due to maturation of native arteriovenous fistula (nAVF) or catheter dysfunction in hemodialysis patients with no clinically apparent infection. MATERIALS AND METHODS: A total of 229 patients (43.2% [n = 99] female and 56.8% [n = 130] male), who underwent hemodialysis through a TDC, were included in this study. Tip cultures of TDCs removed in an operating room and under sterile conditions were collected. All patients were asymptomatic for catheter infection and had not received antibiotic therapy for the last month. RESULTS: The median duration of catheterization was 80 days (min: 5, max: 2880). Bacterial growth was observed in a total of 62 (27.1%) patients. The most common microorganisms were Staphylococcus epidermidis and Staphylococcus aureus. The asymptomatic infection rate was highest in catheters placed through the right and left subclavian veins; however, this was not statistically significant due to the small number of patients. Placement and usage time of TDCs were found to be the most significant factors for bacterial growth in the catheter tip culture (P < .001). CONCLUSION: Prolonged duration and use of the catheter is significant in terms of bacterial load. The use of TDC as vascular access in renal replacement therapy should be avoided as much as possible.

Oxidative status and antioxidant enzyme levels in deep venous thrombosis patients.

Deep vein thrombosis (DVT), a subset of venous thromboembolism (VTE), is a major preventable cause of morbidity and mortality worldwide. We aim to investigate changes in oxidative injury markers and the levels of antioxidant parameters in DVT patients. 50 DVT patients who were admitted to the cardiovascular surgery clinic with acute (<2 weeks) or chronic (≥4 weeks) DVT and 100 healthy individuals were included. As oxidative injury marker malondialdehyde and the antioxidant parameters including reduced glutathione, glutathione peroxidase, catalase, and superoxide dismutase were analysed in the collected peripheral blood samples. Demographic characteristics of the acute and chronic DVT patients were similar (P>0.05). In all DVT patients having thrombosis in the distal and proximal leg veins the mean malondialdehyde and glutathione peroxidase activity were significantly increased, but superoxide dismutase activity significantly decreased, compared to the healthy controls (P<0.05). No difference was observed between distal and proximal DVT patient groups. The increased levels of malondialdehyde in our study is considered to result from the significant decrease in the antioxidant enzyme activity of superoxide dismutase. Furthermore, we are of the opinion that the increased levels of glutathione peroxidase enzyme activity observed in all patients could not compensate the reduction in the superoxide dismutase activity, thereby being insufficient in preventing the increase in the malondialdehyde levels.

Procedure and Clinical Success of Drug-Coated Balloon Fistuloplasty of the Drainage Vein in Dysfunctional Native Arteriovenous Fistulas.

PURPOSE: Native arteriovenous fistulas (AVFs) are the most effective vascular access (VA) for haemodialysis. We aimed to evaluate the results of balloon angioplasty (fistuloplasty) from drainage vein performed for the treatment of AVF dysfunction in haemodialysis patients and examine potential patient and AVF-associated factors that might affect such results. METHODS: This is a nonrandomized, retrospective, and single-centred study. A total of 105 balloon fistuloplasties were performed for dysfunctional AVFs of 82 haemodialysis patients. Patients were treated with a drug-coated balloon according to standard procedures. Evaluations were performed by physical examinations and if needed by color Doppler imaging in every 6 months. The primary endpoint was patency by balloon fistuloplasty. Patency was evaluated clinically by detecting the thrill in AVF and by the adequacy of the dialysis. Multidimensional scaling (MDS) technique was used as a method for the statistical analysis. RESULTS: The success of the procedure after the first attempt was 85.3% with 70 patients. Patency in the 6th, 12th, 18th, and 24th months were 63 (76.8%), 60 (73.1%), 53 (64.6%), and 44 (54%), respectively. The procedure was considered successful when the thrill was detected in AVF and when dialysis was adequate. The statistical analysis by MDS revealed that patients' age was the most effective factor acting on the procedure success followed by the age of AVF. Other patient-associated and AVF-associated factors were not found as effective statistical evaluation. CONCLUSIONS: Haemodialysis through native AVFs with restored functionality contributes positively to the life span and the quality of life of the patient. Probably, advanced age and high fistula age are unfavourable factors leading to the development of neointimal hyperplasia and venous stenosis. Balloon fistuloplasty of the draining vein is an effective and safe method regardless of patient age and the age of AVF.

The Factors Affecting Rhythm Control for Cryoablation of Atrial Fibrillation in Mitral Valve Surgery.

OBJECTIVE: To evaluate the factors impacting on the conversion to sinus rhythm and on the postoperative rhythm findings in the six-month follow-up period of a mitral valve surgery combined with cryoablation Cox-Maze III procedure, in patients with atrial fibrillation. METHODS: In this study, we evaluated 80 patients who underwent structural valve disease surgery in combination with cryoablation. Indications for the surgical procedures were determined in the patients according to the presence of rheumatic or non-rheumatic structural disorders in the mitral valve as evaluated by echocardiography. Cox-Maze III procedure and left atrial appendix closure were applied. RESULTS: The results of receiver operating characteristics analysis indicated that the rate of conversion to the sinus rhythm was significantly higher in patients with left atrial diameters ≥ 45.5 mm and with ejection fraction (EF) ≥ 48.5%. However, the statistical differences disappeared in the sixth month. Thromboembolic (TE) events were seen only in three patients in the early period and no more TE events occurred in the six-month follow-up period. CONCLUSION: The EF and the preoperative left atrial diameter were determined to be the factors impacting on the conversion to sinus rhythm in patients who underwent mitral valve surgery in combination with cryoablation. Mitral valve surgery in combination with ablation for atrial fibrillation does not affect mortality and morbidity in the experienced health centers; however, it remains controversial whether it will provide additional health benefits to the patients compared to those who underwent only mitral valve surgery.

The factors affecting rhythm control for cryoablation of atrial fibrillation in mitral valve surgery

Abstract Objective: To evaluate the factors impacting on the conversion to sinus rhythm and on the postoperative rhythm findings in the six-month follow-up period of a mitral valve surgery combined with cryoablation Cox-Maze III procedure, in patients with atrial fibrillation. Methods: In this study, we evaluated 80 patients who underwent structural valve disease surgery in combination with cryoablation. Indications for the surgical procedures were determined in the patients according to the presence of rheumatic or non-rheumatic structural disorders in the mitral valve as evaluated by echocardiography. Cox-Maze III procedure and left atrial appendix closure were applied. Results: The results of receiver operating characteristics analysis indicated that the rate of conversion to the sinus rhythm was significantly higher in patients with left atrial diameters ≥ 45.5 mm and with ejection fraction (EF) ≥ 48.5%. However, the statistical differences disappeared in the sixth month. Thromboembolic (TE) events were seen only in three patients in the early period and no more TE events occurred in the six-month follow-up period. Conclusion: The EF and the preoperative left atrial diameter were determined to be the factors impacting on the conversion to sinus rhythm in patients who underwent mitral valve surgery in combination with cryoablation. Mitral valve surgery in combination with ablation for atrial fibrillation does not affect mortality and morbidity in the experienced health centers; however, it remains controversial whether it will provide additional health benefits to the patients compared to those who underwent only mitral valve surgery.

MnSOD, CAT and GPx-3 genetic polymorphisms in coronary artery disease.

In this study, we aimed to determine the gene polymorphisms of antioxidant enzymes that determine or affect antioxidant activity in the occurrence of the disease and/or complications during and after the surgery in patients who were decided to undergo coronary artery bypass surgery due to coronary artery disease. Blood samples taken before operation in 26 coronary artery patients who were decided to be operated according to the international procedure and the phenol/chloroform method was used to isolate DNA. DNA samples were amplified by using polymerase chain reaction (PCR) method with specific primers for MnSOD, CAT, GPx-3 antioxidant gene regions. As a result of the increasing process, the PCR products for the purpose of determining gene polymorphism, NGOMIV SMA f and BSA I restriction enzymes were used for MNSOD, CAT and GPx-3 gene region, respectively. Allele frequencies were determined and compared by Chi square test. VV (46.15%) and VA (53.85%) genotype for MnSOD region, i TT (22.22%), TC (16.67%) and CC (61.11%) genotype for CAT region, and CC (12.50%), TC (25%) and TT (62.50%) genotypes for GPx-3 region were obtained. While there was no statistically significant significance in terms of genotypes obtained in MnSOD and GPx-3 gene regions (P > 0.05), a significant difference was found in the CAT gene region in terms of genotypes (P < 0.01). Although oxidative stress is important in relation to cardiovascular diseases and postoperative complications, virtually no study of antioxidant enzymes in gene polymorphism are included in the literature. Work is lacking in relation to the subject.

The Effect of On-Pump and Off-Pump Bypass Operations on Oxidative Damage and Antioxidant Parameters.

OBJECTIVE: The aim of the study is to determine the oxidative status in on-pump and off-pump coronary artery surgery and contribute to possible surgical choices in clinical practices in accordance with the information obtained as a result of this study. METHODS: 52 patients undergoing open heart surgery (26 patients in on-pump group and 26 patients in off-pump group) were included in the study. MDA, GPx, GSH, CAT, and SOD were investigated in blood samples. RESULTS: In the on-pump group, it was determined that there were a significant increase in MDA level in the peroperative period compared to the preoperative and postoperative periods and a significant increase in GSH level in the postoperative period than in the preoperative period. Additionally, while there was a significant decrease in CAT activity in the postoperative period than in the peroperative period, there was a statistically significant increase in SOD enzyme activity in the postoperative period compared to the preoperative and peroperative periods. A statistically significant increase was observed in SOD enzyme activity in the postoperative period in on-pump compared to off-pump group. CONCLUSION: It is thought that this oxidative damage can be suppressed by administering a suitable antioxidant supplement in the preoperative and peroperative periods among patients undergoing the on-pump operation.

Change in Free Radical and Antioxidant Enzyme Levels in the Patients Undergoing Open Heart Surgery with Cardiopulmonary Bypass.

Objective. The purpose of this study is to determine the changes in oxidative damage and antioxidant parameters in open heart surgeries with cardiopulmonary bypass (CPB) in preoperative and early postoperative periods. Methods. A total of three consecutive arterial blood samples were obtained from the patients in the study group, in preoperative, early postoperative, and postoperative periods, respectively. Oxidative damage indicator (MDA) and antioxidant indicators (GPx, GSH, CAT, and SOD) were examined. Results. A statistically significant increase was observed in MDA level in postoperative period compared to preoperative and early postoperative periods. GSH levels and CAT activities increased significantly in early postoperative and postoperative periods. Analyses revealed an increase in GPx and SOD enzyme activities only in the postoperative period. Conclusion. Even though the increase in MDA level was suppressed by the increased GSH level and CAT activity like in early postoperative period, efficiency can be brought for the increases in insufficient significant antioxidant parameters in postoperative period by administering antioxidant supplements to the patients and thus the increase in MDA in postoperative period can be significantly suppressed.