Cardioplegic arrest is one of the most common myocardial protection strategies. A wide variety of cardioplegic solutions are routinely being used. There is an ongoing discussion about the relative effectiveness of these solutions considering myocardial protection. This study aims to investigate the hypothesis that the use of histidine-tryptophan-ketoglutarate (HTK) cardioplegia leads to decreased ischemic damage on myocardium compared with the use of conventional crystalloid cardioplegia. The study population was 32 patients operated on at Başkent University, Department of Cardiovascular Surgery for congenital heart diseases. The first group of 16 patients received conventional crystalloid cardioplegia (KK group) which is a modification of St. Thomas' solution, while the second group of 16 patients received HTK solution (HTK group). The echocardiographic measurements and the laboratory values of the patients were taken as the clinical variables. Right ventricular biopsies were taken from every patient before and after cardioplegic arrest. These biopsies were histopathologically examined for apoptosis using caspase-3 antigen and cell proliferation using Ki-67 antigen. The statistical analysis revealed no significant difference between the two groups regarding the clinical variables, apoptotic indices and proliferation indices. The apoptotic indices in the postcardioplegic arrest biopsies positively correlated with aortic clamp time in the KK group but not in the HTK group. Liver function tests on postoperative day 1 positively correlated with aortic clamp time in both groups. On postoperative day 2, this correlation was sustained in the KK group and ceased in HTK group. The difference in the correlation of apoptotic indices and liver function tests between the groups is accepted as a supportive finding for HTK solution. However, it can be postulated that when the aortic clamp times are similar to those in the present study, the clinical manifestation of the difference between the two solutions would not be significant.

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.

The effects of pulsatile perfusion on microcirculation and renal function in high-risk patients were evaluated in this study. Pulsatile roller pumps with a pulsatile control module and membrane oxygenator were used in a clinical setting. 40 patients undergoing elective cardiac surgery with a high risk of either having chronically obstructive pulmonary disease or chronic renal failure were randomly included in the study to be perfused using pulsatile or continuous flows. Blood samples were collected at induction of anesthesia, at the time of aortic clamping and declamping and 1 and 24 h following cessation of the bypass. Urea and creatinine concentrations in blood were measured and systemic vascular resistance was calculated. Urine output, crystalloid and colloid infusions were recorded. We observed that pulsatile roller pump perfusion and the extracorporeal circuit used in the clinical study improved microcirculation and renal function in high-risk patients undergoing cardiopulmonary bypass.

Unibody bifurcated endografts have the advantage of reducing the operative time, avoiding migration and iliac limb dislocation in patient with abdominal aortic aneurysm (AAA). We report our longterm experience in patients who underwent endovascular aortic repair (EVAR) due to infrarenal AAA with Endologix AFX® endograft system. Between January 2013-December 2018, 68 patients with infrarenal AAA had EVAR procedure with Endologix AFX® endograft system. Mean follow-up was 40.4 ± 19.5 months, and all patients had computed tomography periodically, with colored Doppler ultrasonography (CDUS) every six months. Mean age was 68.5 ± 7.1 years and, 63 (92.6%) patients were male. Early mortality, renal complications, stent-graft migration and cardiac complications were not seen in early post-operative period. There was no early mortality in the group and no conversion to open repair. In long-term follow-up 12 patients (17.6%) had endoleak (5 with type II, 7 with type III). Overall survival estimated by Kaplan-Meier analysis was 94.1% at 1 year, 85.2% at 2 years, 74.1% at 3 years and 54.0% at 5 years. Freedom from second intervention and conversion was 98.4% at 1 year, 95.3% at 2 years, 93.3% at 3 years and 87.4% at 5 years. Endologix AFX® endograft provides a fast, safe and effective endograft for the early period, therefore it seems more suitable for elderly and comorbid patients. This endograft has low reintervention rates however according to our results, aneurysms larger than 6 cm may have more sideway displacement possibility and by this way type III endoleak. Proper patient selection and sufficient overlap are the key issues. Close monitoring is mandatory at the follow-up period.

Introduction Women are less likely to develop infrarenal abdominal aortic aneurysm; however, when they do, it is almost always associated with challenging anatomy, more rapid aneurysmal growth rate and earlier rupture. Women generally have poorer outcomes following open aneurysm repair; and in this respect, the present study aims to evaluate if it is so after endovascular repair. Methods A retrospective analysis of our database was performed for patients underwent endovascular aneurysm repair (EVAR) between January 2013–March 2020. 249 elective EVAR patients were evaluated. Patients were categorized according to gender and 26 patients (10.4%) were female. Demographics and pre-peri-postoperative findings were compared. Propensity score matching (ratio 1:1) was performed to reduce selection bias. Results In the overall unmatched cohort, female population had more diabetes mellitus (p = 0.016) and hypertension (p = 0.005). However, coronary artery disease (p = 0.005) and coronary artery bypass grafting (p = 0.006) were more in male gender. Non-IFU implantation was higher in female group (38.5% vs. 11.5%, p = 0.025). After propensity matching, even though it was not statistically significant, early mortality for female gender was higher when compared to male gender (7.7% and 0%, respectively, p = 0.490). In the follow-up period, no difference in all-cause mortality, secondary interventions or complications have been observed between the genders. Conclusion Challenging anatomy and subsequently treated patients outside IFU may be the reasons for higher morbidity and mortality in women. However, despite these factors female and male patients revealed equivalent early and late results.

Introduction: Endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is increasingly used, and has become the standard treatment option for AAA. Aim: To evaluate the outcomes and predictors of survival of endovascular treatment of AAA in the short-and medium-term. Material and methods: A total of 222 patients having endovascular AAA repair between January 2013 and December 2019 by the same surgical team were included in the study. Patient demographics, perioperative and follow-up data including mortality, complications, and need for secondary intervention were collected. The primary endpoint was all-cause mortality. Kaplan-Meier analysis was conducted for survival and Cox regression models were assessed for predictors of survival. Results: The median age was 70 years, with male predominance (202 patients, 91%). Thirty-day mortality was 1.8%. Median follow-up to the primary endpoint was 20 months (range: 1-80 months).

Successful implementation of a patient blood management program necessitates the collaboration of a strong organization and a multidisciplinary approach. We organized a meeting with broad participation in our center to establish a consensus for implementation of a specific patient blood management program. International and domestic experiences were shared, the importance of coordination and execution of different pillars in patient blood management were discussed, and the problems about the blood transfusion system were also investigated with the proposal for solutions. The data obtained from this meeting are presented to be a guide for similar large-volume tertiary hospitals for integration of a patient blood management protocol.

Aim: Blunt traumatic thoracic aortic injury (BTTAI) is a catastrophic life-threatening surgical emergency and the second most common cause of death in trauma patients. We retrospectively revealed our results for endovascularly treated BTTAI with early and long-term results. Material and Methods: During January 2009 and January 2022, patients from the emergency department with diagnosed BTTAI were retrospectively revealed. 38 patients all male except two, experienced BTTAI. 5 patients had grade IV, and 21 patients had grade III aortic injuries. Results: Mean age of the patients was 41.7±12.5 years. Technical success was 100%. Early mortality was 7.9%. The mean follow-up period was 49.7±18.3 months. In the follow-up period, there were no TEVAR-related complications. Conclusion: TEVAR is the most suitable treatment for BTTAI in the modern era. Left subclavian artery (LSA) intentional coverage may be performed however surgeon modified fenestrated stent graft (SMFSG) is an effective, economic, fast, and readily available technique for LSA revascularization without additional time.