On-pump coronary artery bypass grafting can be performed in patients with ejection fraction ≤30%, with reasonable mortality and morbidity rates.

BackgroundWe aimed to investigate the preoperative, operative, and postoperative factors affecting intra-aortic balloon pump (IABP) insertion in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). We also investigated factors affecting morbidity, mortality, and survival in patients with IABP support.MethodsBetween January 2002 and December 2009, 1,657 patients underwent isolated CABG in İzmir Katip Celebi University Atatürk Training and Research Hospital. The number of patients requiring support with IABP was 134 (8.1%).ResultsIn a multivariate logistic regression analysis, prolonged cardiopulmonary bypass time and prolonged operation time were independent predictive factors of IABP insertion. The postoperative mortality rate was 35.8% and 1% in patients with and without IABP support, respectively (p=0.000). Postoperative renal insufficiency, prolonged ventilatory support, and postoperative atrial fibrillation were independent predictive factors of postoperative mortality in patients with IABP support. The mean follow-up time was 38.55±22.70 months and 48.78±25.20 months in patients with and without IABP support, respectively. The follow-up mortality rate was 3% (n=4) and 5.3% (n=78) in patients with and without IABP support, respectively.ConclusionThe patients with IABP support had a higher postoperative mortality rate and a longer length of intensive care unit and hospital stay. The mid-term survival was good for patients surviving the early postoperative period.

ÖZAmaç: Bu çalışmada arkus aort anevrizmalarının tedavisinde hibrid işlem ve açık cerrahi sonuçları karşılaştırıldı.Ça lış mapla nı:Ocak 2004 -Ocak 2010 tarihleri arasında arkus aort anevrizması nedeniyle total arkus aort replasmanı yapılan 26 hasta (21 erkek, 5 kadın; ort. yaş 56.6±12.4 yıl; dağılım, 20-83 yıl) retrospektif olarak değerlendirildi. Hastalar açık konvansiyonel cerrahi grubu (grup 1, n=15) ve hibrid işlem (aynı seansta total arkus aort debranching ve endovasküler stent implantasyonu) grubu (grup 2, n=11) olarak iki gruba ayrıldı. Sağkalım oranları ve tekrar ameliyat gereksinimi gruplar arasında karşılaştırıldı. Bul gu lar:Ameliyat sonrası revizyon, ekstübasyon süresi ve drenaj miktarları açısından hibrid işlem daha iyi bulundu. Ancak sağkalım oranları, tekrar ameliyat gereksinimi ve ciddi advers kardiyovasküler olaylar açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu.So nuç: Çalışma sonuçlarımız arkus aort anevrizması nedeniyle total arkus aort replasmanı yapılan hastalarda sağkalım ve kısa ila orta dönem sonuçlar açısından açık konvansiyonel cerrahi ve hibrid işlemin benzer olduğunu göstermektedir.Anah tarsöz cük ler: Arkus aort anevrizması; konvansiyonel açık cerrahi; hibrid işlem. ABSTRACTBackground: This study aims to compare the results of hybrid procedure and open surgery for the treatment of aortic arch aneurysms. Methods:Twenty-six patients (21 males, 5 females; mean age 56.6±12.4 years; range, 20 to 83 years) who underwent total aortic arch replacement for aortic arch aneurysm between January 2004 and January 2010 were retrospectively analyzed. The patients were divided into two groups: open conventional surgery group (group 1, n=15) and hybrid procedure (total debranching of the aortic arch and simultaneous endovascular stent) group (group 2, n=11). Survival rates and need for reoperation were compared between the groups.Results:The hybrid procedure was found to be more favorable in terms of postoperative revision, extubation period, and drainage amounts. However, there was no statistically significant difference in the survival rates, need for reoperation, and major adverse cardiovascular events between the groups. Conclusion:Our study results suggest that conventional open surgery and hybrid procedure are similar in terms of survival and short-to-mid-term results in patients undergoing total aortic arch replacement for aortic arch aneurysm.

Aortic false aneurysm is life-threatening with high morbidity and mortality rates. Surgical treatment varies according to the pathologic process, infection status, and site of origin of the aneurysm. We presented a case of false aneurysm of the ascending aorta, developing after type A acute aortic dissection repair. The operation was performed with the use of deep hypothermia and circulatory arrest to avoid massive uncontrollable hemorrhage.

A 47-year-old female was admitted to our clinic with severe pain in the lower abdomen, lumbar region, and left lower extremity. Contrastenhanced computed tomography showed an irregular and heterogenous soft tissue mass in the inferior of left kidney, and pelvic varicosities. Emergency exploratory laparotomy revealed multiple venous bleeding in the pelvic veins and left internal iliac vein. Bleeding from veins was unable to be stopped by direct suturing. Therefore, distal of the left common iliac vein, proximal of the left external iliac vein, and left internal iliac vein were ligated. The postoperative follow-up period was uneventful. In conclusion, retroperitoneal venous hemorrhage accompanied by deep venous thrombosis of the lower extremity is a serious condition with high morbidity and mortality. Timely surgical and medical treatment is life-saving.

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