Ascending venous arterialization can be applied for limb salvage to the patients who do not have a suitable arterial bed to revascularize with conventional techniques.

No abstract

Intracoronary shunt reduced the postoperative troponin I levels significantly, so it may be indicated in the patients who are thought to be susceptible to transient ischemia.

In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.

Aims  Time of showering after surgery is still a controversial issue for surgical patients and health professionals. We evaluated the effects of showering in 48–72 h after median sternotomy on sternal wound infections, pain due to sternotomy, patient comfort, and satisfaction levels. Methods and results  The study was a randomized controlled clinical trial. Fifty-one patients were randomly allocated (1:1) to the shower (n = 26) or non-shower group (n = 25). The patients in the shower group (intervention group) showered in the first 48–72 h after surgery and the patients in the non-shower group (control group) were not allowed to shower until their chest tube sutures were removed. They were instructed to shower on the next day after removal of the chest tube sutures. The rate of sternal wound infections was significantly lower in the shower group (n = 2, 7.7%) than in the non-shower group patients (n = 8, 32.0%; P = 0.038). A logistic regression analysis showed that early post-operative showering was protective and significantly reduced the risk of sternal wound infections independently of other variables [odds ratio (OR): 0.177; 95% confidence interval (CI): 0.033–0.940; P = 0.042]. The pain severity score was significantly lower in the shower group patients. Also, comfort and satisfaction scores were significantly higher in this group (P < 0.05). Conclusion  Early showering after sternotomy was found to be protective against sternal wound infections and had a positive effect on pain, comfort, and satisfaction. Trial registration  Clinical Trials.gov registration number NCT04250961 (https://clinicaltrials.gov/ct2/show/NCT04250961).

Sub-foveal choroidal thickness and ocular pulse amplitude are unchanged, while intraocular pressure decreases one week and one month after cardiopulmonary bypass.

No abstract

Cardiopulmonary bypass has been reported to have many effects on the immune system. The aim of this study was to investigate the efficiency and usefulness of off-pump coronary artery bypass (OPCAB) surgery on patients who had coronary artery disease besides malign neoplasia. We applied OPCAB operations to 217 patients between March 2001 and April 2004, ten of whom had malign neoplasia. These patients were diagnosed to have coronary artery disease on their routine examination for their oncologic operation. The malignancies were stomach cancer (2 patients), colon-rectum carcinoma (3 patients), breast carcinoma (2 patients), surrenal carcinoma (1 patient), larynx carcinoma (1 patient), and meningioma (1 patient). The patients were operated on for their neoplasia by the related clinics at a mean of 42 days after the OPCAB surgery. The patients were discharged with surgical success and without any cardiac complications. Coronary artery bypass surgery before a noncardiac major operation may effectively decrease the long-term mortality due to myocardial ischemia. Severe coronary artery disease should be surgically treated in those patients who are scheduled to undergo an operation for malign neoplasia. Extracorporeal circulation impairs the immune system and negatively affects the defense of host against malignancy. Therefore, patients with severe coronary artery disease who are candidates for oncologic operation should be treated with OPCAB.