The control of sternal bleeding during cardiac surgery can sometimes be a challenging and time-consuming problem for surgeons. Several alternatives for the control of sternal bleeding are on the market. Bone wax is a well-known alternative used by many cardiac surgeons for the control of bleeding. It is effective and cheap; however, it inhibits ossification of the sternum and can cause infections and sternal wound healing problems after cardiac surgery. Consequently, control of sternal bleeding without the use of bone wax requires meticulous preparation. Ankaferd Blood Stopper (ABS) (Ankaferd Sağlik Ürünleri, Istanbul, Turkey) is a unique folkloric medicinal plant extract that has been used in Turkish traditional medicine as a hemostatic agent. We present a practical alternative technique for the control of sternal bleeding during cardiac surgery with the use of ABS.

Although several left ventricular assist devices (LVADs) have been used widely, remote monitoring of LVAD parameters has been available only recently. We present our remote monitoring experience with an axial-flow LVAD (HeartAssist-5, MicroMed Cardiovascular, Inc., Houston, TX, USA). Five consecutive patients who were implanted a HeartAssist-5 LVAD because of end-stage heart failure due to ischemic (n=4) or idiopathic (n=1) cardiomyopathy, and discharged from hospital between December 2011 and January 2013 were analyzed. The data (pump speed, pump flow, power consumption) obtained from clinical visits and remote monitoring were studied. During a median follow-up of 253 (range: 80-394) days, fine tuning of LVADs was performed at clinical visits. All patients are doing well and are in New York Heart Association Class-I/II. A total of 39 alarms were received from three patients. One patient was hospitalized for suspected thrombosis and was subjected to physical examinations as well as laboratory and echocardiographic evaluations; however, no evidence of thrombus washout or pump thrombus was found. The patient was treated conservatively. Remaining alarms were due to insufficient water intake and were resolved by increased water consumption at night and summer times, and fine tuning of pump speed. No alarms were received from the remaining two patients. We believe that remote monitoring is a useful technology for early detection and treatment of serious problems occurring out of hospital thereby improving patient care. Future developments may ease troubleshooting, provide more data from the patient and the pump, and eventually increase physician and patient satisfaction. Despite all potential clinical benefits, remote monitoring should be taken as a supplement to rather than a substitute for routine clinical visits for patient follow-up.

During CPB, serum S100beta protein level increases and this increase is higher in the nonpulsatile group. High serum level of S100beta protein is associated with increased levels of serum inflammatory mediators and systemic inflammatory response.

EVLA of the GSV insufficiency using 980-nm diode laser is an effective and safe technique with a high patient satisfaction rate. The advantages of the procedure are that it is performed as an outpatient procedure, provides early mobilization, causes minimal cessation of daily activities, and avoids classic surgical complications.

The aim of this study was to demonstrate the beneficial effects of aminophylline on protamine cardiotoxicity. Thirty-four patients were examined, 17 of whom received aminophylline 3 mg/kg before protamine administration, being the study group, while the other 17, being the control group, did not. All cardiac output and biochemical measurements were evaluated 5 min following protamine administration. The cAMP level was 43.4 +/- 3.51 pmol/ml in the study group and 18.7 +/- 2.98 in the control group (P < 0.0001) before protamine administration, while the oxygen extraction rate decreased from 49% to 44 +/- 2% in the control group, and from 51.2% to 47 +/- 3% in the study group (P < 0.03). The N-acetyl glucosaminidase value was 16.9 +/- 13.9 pmol/ml in the study group and 27.8 +/- 1.47 pmol/ml in the control group (P < 0.01), and myocardial lactate extraction was -0.20 +/- 0.03 in the control group and -0.07 +/- 0.07 in the study group (P < 0.001). The left ventricular stroke work index was 28.6 +/- 3.14 gm/m2 in the control group and 37 +/- 6.77 gm/m2 in the study group (P < 0.002). The findings of this study led us to conclude that the adverse effects of heparin neutralization using protamine can be relieved by aminophylline.

SummaryIntroduction:Left ventricular assist device (LVAD) implantation is a viable therapy for patients with severe end-stage heart failure, providing effective haemodynamic support and improved quality of life. The Heart Assist 5 (Micromed Cardiovascular Inc, Houston, TX) continuous-flow LVAD has been on the market in Europe since May 2009.Methods:We evaluated nine Heart Assist 5 LVAD patients with two- and three-dimensional transthoracic echocardiographic (TTE) and transoesophageal echocardiographic (TEE) parameters between December 2011 and December 2013. The pre-operative TTE LVAD evaluations included left ventricular (LV) function and structure, quantification of right ventricular (RV) function and tricuspid regurgitation (TR), assessment of aortic and mitral regurgitation, and presence of patent foramen ovale and intra-cardiac clots. Peri-operative TEE determined the inflow cannula and septum position, and assessed the de-airing process while weaning from cardiopulmonary bypass. Post-operative serial follow-up TTE showed the surgical results of LVAD implantation, determined the overall structure and function of the LV, RV and TR, and observed the inflow and outflow cannula position.Results:Nine patients who had undergone Heart Assist 5 LVAD implantation and had been followed up for more than 30 days were included in this study. Eight patients had ischaemic cardiomyopathy and one had adriamycin-induced cardiomyopathy. Pre-implantation data: the mean age of the patients was 52 ± 13 (34–64) years, mean body surface area (BSA) was 1.8 ± 0.2 (1.6–2.0) m2, mean cardiac index (CI) was 2.04 ± 0.4 (1.5–2.6) l/min/m2, mean cardiac output (CO) was 3.7 ± 0.7 (2.6–4.2) l/min, mean ejection fraction (EF) was 23 ± 5 (18–28)%, and right ventricular fractional area contraction (RVFAC) was 43 ± 9 (35–55)%. One patient had aortic valve replacement (AVR) during the LVAD implantation, and excess current alarms and increased power were suspected to be caused by a possible thrombus. Close follow up with TTE studies were carried out to clear the LV of thrombus formation, and the inflow cannula position was checked to maintain the septum in the midline, so preventing the suction cascade. Four patients were followed up for more than two years, and two were followed up for more than a year. Three patients died due to multi-organ failure. Follow-up speed-change TTE studies of six patients showed that the mean speed was 9 800 ± 600 (9 500–10 400) rpm, and mean CO was 4.7 ± 0.3 (4.3– 5.0) l/min during the three-month post-implant period.Conclusion:We believe that TTE can play a major role in managing LVAD patients to achieve optimal settings for each patient. A large series is mandatory for assessment of echocardiographic studies on Heart Assist 5 LVAD.

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This study was planned to show the beneficial effects of prostacyclin (PGI2) utilization on adverse effects of protamine. PGI2 was administered at a rate of 5 ng/kg/min. Twenty patients entered this study. Half of them received PGI2 whereas the others did not. Right ventricular end-diastolic volume index and right ventricular stroke work index were 72 mL/m2 and 2.2 g.m/m2, respectively, after patients were weaned off the bypass and 79 and 1.5, respectively, at five minutes after pro tamine administration in the control group; these values were 88 and 3.2, re spectively, and 86 and 3, respectively, in the PGI2 group. Left ventricular stroke work index (g.m/m2) was 27.9 in the control group and 36.7 in the PGI2 group (p < 0.05) after protamine administration. Thromboxane B2 levels (pmoL/mL) in coronary sinus (CS) blood were 251 in the control group and 90 in the PGI2 group at five minutes after protamine administration (p < 0.05). Myocardial blood flow was 174 mL in the control group and 245 mL in the PGI2 group at five minutes after protamine adminis tration (p < 0.05). Cyclic adenosine monophosphate (cAMP) and cyclic guano- sine monophosphate (cGMP) levels in CS blood were 17 pmoL/mL and 2.1 pmoL/mL, respectively, in the control group and 36 and 0.3, respectively, in the PGI2 group at five minutes after protamine administration. Leukotriene B4 level was 129 and 57 pmoL/mL in the control and PGI2 groups, respectively (at the same time as the cAMP measurement) (p < 0.05). From the results of this study the authors conclude that adverse effects of heparin reversal with protamine can be reduced with the use of PGI2.