ÖZKoronavirüs hastalığı-2019 (COVID-19) tüm dünyada sağlık çalışanlarını alarm durumuna geçiren ciddi bir sağlık sorunudur. Pandeminin beraberinde getirmiş olduğu ve sağlık sistemini ilgilendiren ele alınması gereken iki önemli konu mevcuttur. Birincisi; pandeminin yayılma hızına yetişme sıkıntısı çekebilecek olan sağlık sisteminin yükünü azaltabilmek açısından elektif birçok işlemin/cerrahinin ertelenmesi gerekliliğidir. Bu nedenle, cerrahi gereken kardiyovasküler hastalıkların önceliğinin ve ertelenebilirliğinin belirlenmesi için "Öncelik Düzeyi" olarak adlandırdığımız bir algoritma geliştirilmesini amaçladık. İkinci olarak ise; kardiyovasküler cerrahi yapılması gereken acil ve öncelikli hastalarda cerrahinin ve sonrasında yoğun bakım ünitesinde takibinin, enfeksiyon koruma tedbirlerinin sağlandığı bir ortamda yapılması gerekliliğidir. Bu yazıda, hasta güvenliğinin sağlanabilmesi ve cerrahi ekibin maksimum seviyede korunabilmesi için uygulanabilecek olan gerekli tedbirler sunuldu.
ABSTRACTCoronavirus disease-2019 (COVID-19) is a serious health concern which alert all healthcare professionals worldwide. There are two main issues caused by this pandemic regarding for the healthcare system. First, it is a necessity to postpone many elective procedures/surgeries to reduce the burden of the healthcare system which may be confronted with strain by the increased speed of transmission. Therefore, we aimed to develop an algorithm called as Level of Priority to identify the priority and deferrability of cardiovascular diseases requiring surgery. Second, it is essential to perform surgery and intensive care unit follow-up in a setting where the infection prevention measures are followed for primary patients requiring emergency cardiovascular surgery. In this article, we present necessary precautions to be exercised to provide the patient safety and the highest level of protection for the surgical team.
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).
Currently, thoracic endovascular aortic repair is usually the first-line treatment option for descending aortic pathologies. Supra-aortic or visceral branches sometimes involve assistive thoracic endovascular aortic repair techniques; hybrid procedures or intentional coverage may be performed during the procedure to achieve a sufficient proximal or distal landing zone. Most surgeons may agree on selective coverage of celiac truncus, but revascularization is preferred to reduce the risk of ischemic complications. Herein, we present the first successful surgeonmodified fenestrated stent graft procedure for celiac truncus in a patient with Crawford type V descending aortic aneurysm in Türkiye.
Background: In this study, we present our mid-term results in patients undergoing treatment with the funnel technique and describe technical issues for this bailout technique in extra-wide infrarenal necks.
Methods: Between January 2018 and June 2020, a total of seven male, symptomatic patients (median: 74.5 years; range, 64 to 84 years) who had comorbidities and were in the American Society for Anesthesiologists Class IV and treated by the funnel technique in an endovascular fashion were included. Pre- and post-procedural data of the patients, early mortality and technical success rates were evaluated.
Results: There was no early mortality. Technical success rate was 100%. There was no type I or III endoleaks at the completion angiography. All patients were discharged without any problem on the second or third day of the procedure. The median follow-up was 13 (range, 6 to 28) months. The aneurysm sac shrinkage was achieved in all patients over six months of follow up. During the follow-up period, no proximal endoleak or infrarenal aortic neck diameter enlargement was found.
Conclusion: Based on our limited experience, the funnel technique may be considered more than a bailout procedure under special circumstances.
Background: The perioperative risk factors that cause severe morbidity and prolongation of postoperative hospital stay after cardiac surgery should be determined. Various scores have been used to predict morbidity and mortality. Preoperative blood counts are considered potential biomarkers of inflammation and oxidative stress. Inflammatory and immune imbalances may have a significant impact on postoperative adverse events. The present study aimed to investigate the association and potential predictive properties of red cell distribution width/lymphocyte ratio (RLR) for major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass. Methods: After approval from the ethics committee, pre- and post-operative data of 700 patients were obtained from the electronic database of the hospital, intra- and post-operative anesthesia, and ICU follow-up charts. We performed a stepwise multiple logistic regression analysis to investigate the association of RLR with major adverse events in adult patients who underwent coronary surgery with cardiopulmonary bypass.Results: Among 700 patients, 47 (6.7%) had major adverse events after surgery. Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.03–1.12; P < 0.001), mean platelet volume (OR, 1.49; 95% CI, 1.07–2.06; P = 0.017), and RLR (OR, 1.21; 95% CI, 1.02–1.43; P = 0.026) were significantly associated with major adverse events.Conclusions: RLR indicates the balance between inflammatory and immune responses. Therefore, it can be used to predict adverse events following coronary surgery.
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