Background: Transcatheter closure is the preferred method for atrial septal defect (ASD) closure. Robotic surgery has become the least invasive technique for ASD closure. Therefore, we sought to evaluate the outcomes in patients who underwent ASD closure with transcatheter or robotic surgery techniques.Methods: A total of 462 patients underwent totally endoscopic robotic (n = 217) or transcatheter ASD closure (n = 245). Demographic data, perioperative data, and outcomes were compared.Results: The mean age was lower in the robotic surgery group than the transcatheter group (31.4 ± 11.8 vs 39.4 ± 13.2 years; P = .001). Ventilation time, intensive care unit (ICU) stay, and hospital stay was significantly lower in the transcatheter group. The postoperative new-onset neurological event was seen in one (0.5%) patient in robotic surgery, and four (1.6%) patients in the transcatheter closure group.New-onset atrial fibrillation was found to be higher in transcatheter closure (two vs seven patients; P = .133) group. Surgical conversion to a larger incision occurred in two patients (1%) in robotic surgery, while two patients (0.5%) underwent emergency median sternotomy due to device embolization to the main pulmonary artery.There was no mortality in both groups. During follow-up, one patient (0.5%) who underwent robotic surgery was reoperated, and two patients (0.8%) who underwent transcatheter procedure required surgical intervention due to device migration and severe residual shunting (P = .635).Conclusion: Both transcatheter and robotic surgery approaches had excellent outcomes but transcatheter closure had shorter hospital and ICU stays. Robotic surgery provides a similar complication risk that can be comparable to the transcatheter approach as well as patient comfort and cosmetic advantage over the other surgical techniques. K E Y W O R D Satrial septal defect, minimally invasive, robotic surgery, transcatheter

Objectives To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure ( P <0.). In contrast, preserved ejection fraction value favored graft patency ( P <0.001). Conclusion Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.

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Background: This study aimed to examine the effect of pulsatile flow pattern on tissue perfusion, particularly cerebral tissue perfusion, at pre-determined intervals during CPB, as well as its effects on postoperative morbidity and mortality. Methods: This retrospective study included 134 adult patients, who underwent cardiac surgery with cardiopulmonary bypass (CPB). Patients were grouped based on the flow pattern used during CPB: non-pulsatile CPB group (N = 82) and pulsatile CPB group (N = 52). Cerebral oxygen saturation, arterial pH and arterial lactate levels were measured at four time points, during the operation and the 2 groups were compared with regard to changes over time as well as differences in postoperative outcomes. Results: The 2 groups were similar, in terms of mean values and intraoperative changes in cerebral oxygen saturation and arterial pH. Non-pulsatile CABG group had significantly higher arterial lactate levels over the measurement period, which was not affected by the timing of the measurements. Postoperative drainage, duration of ventilation and duration of hospital stay significantly were higher and postoperative blood urea nitrogen significantly was lower in the non-pulsatile CPB group. Other postoperative outcomes were similar across the groups. Conclusion: Findings of this study do not support the superiority of pulsatile flow pattern during CPB, in terms of cerebral oxygen saturation or postoperative mortality/morbidity. Further and larger comparative studies are warranted before pulsatile blood flow pattern can be established as a routine clinical method.

Introduction: Constrictive pericarditis (CP) is a rare and potentially lethal disease. It is one of the important reasons of the right-sided heart failure, and it requires immediate intervention. The aim of this study was to investigate the short-term and mid-term results in patients who were operated for CP in our hospital center. Patients and Methods: We evaluated data of 27 patients who underwent pericardiectomy due to CP in our center. Clinical findings, results of imaging modalities, the surgical technique, and the follow-up were retrospectively evaluated. Results: The mean age of our patients was 49.78 years. The most common symptom was dyspnea. Peripheral edema was the most common sign during the physical examination. The mean pericardium thickness ranged between 3.4 mm and 6.6 mm in diameter. Total pericardiectomy was performed in 15 patients (55.6%), while partial pericardiectomy was performed in 12 patients (44.4%). Pericardiectomy with concomitant cardiac surgery was performed in 5 patients (18.5%). Unfortunately, postoperative mortality occurred in 4 patients (14.8%). Conclusion: Surgical removal of pericardium is a treatment modality that should be preferred in patients with CP, despite high mortality rates reported in some series.

Tip A aort diseksiyonu nedeniyle altı ay önce Bentall De-Bono ameliyatı yapılan 30 yaşında erkek hasta, kliniğimize istirahat halinde akut alt ekstremite ağrısı ile başvurdu. Varfarin dozu uluslararası normalleştirilmiş oran 2-3 arasında olacak şekilde ayarlandı ve hasta Bentall De-Bono ameliyatı sonrası sorunsuz bir şekilde taburcu edildi. Bilgisayarlı tomografide 2.2 uluslararası normalleştirilmiş oran ile çıkan aort protez greftinde tromboz, sol iliyak arterde tıkanıklık ve dalakta multipl enfarktlar izlendi. Hasta yeniden ameliyata alındı ve çıkan aort protez greftindeki izole trombüs temizlendi. Materyalin patolojik incelemesi kronik trombüsle uyumluydu.

Background: Ischemic mitral valve regurgitation is a subgroup of secondary mitral valve insufficiency that develops due to ischemic heart disease. The aim of the study is to evaluate the patients who were operated after acute myocardial infarction for the type of interventions to be performed for the mitral valve in terms of mortality and morbidity. Methods: It is a single-centered, retrospective study. Patients who were admitted to the hospital with the diagnosis of acute myocardial infarction and operated emergently or urgently between January 2017 and December 2020 were evaluated. Patients who were found to have significant IMR (≥ moderate mitral regurgitation) in the early period and who could achieve complete revascularization were included in the study. Patients were divided into two groups whether the mitral valve was intervened or not. Results: The demographical data of the patients that were included in the study is as follows, 73.4% were male and 33% were female. The average age of the patients was 63.2 ± 8.9. Patients were compared in terms of significant (moderate or higher) postoperative residual mitral regurgitation. 62.2% (n=23) of the patients undergone isolated CABG had mild mitral regurgitation. 5 patients with mitral valve annuloplasty (17.9%) had significant residual regurgitation (p<0.001). Conlusion: Mitral valve intervention should not be considered in non-severe mitral valve insufficiencies (without papillary rupture or chorda rupture) after acute MI. Preservation of the dynamic structure of the mitral valve annulus in the acute period makes mitral ring annuloplasty not an appropriate treatment.

Lower extremity hypoperfusion occurs in 5.7-30% of Stanford type B aortic dissection cases. A 53-year-old male patient presented with type B aortic dissection. His left femoral pulse was not palpable. The proximal left common iliac artery was nearly occluded in computed tomography angiography. There was no extremitythreatening rest pain, but there was intermittent claudication at 100 meters. Cross femoral bypass was planned for the patient under elective conditions. After two months, the left femoral pulse was palpable, and the patient no longer had intermittent claudication. In this study, we report that lower extremity hypoperfusion, which developed after acute type B aortic dissection resolved without open and endovascular surgery.