In elderly, high-risk surgical patients, sutureless aortic valve replacement (AVR) can often be an alternative to conventional AVR; shorter aortic cross-clamp and cardiopulmonary bypass times are the chief advantages. We compared the outcomes of sutureless AVR with those of conventional AVR in 70 elderly patients who underwent concomitant cardiac surgical procedures. We retrospectively analyzed the cases of 42 men and 28 women (mean age, 70.4 ± 10.3 yr; range, 34-93 yr) who underwent cardiac operations plus AVR with either a sutureless valve (group 1, n=38) or a conventional bioprosthetic or mechanical valve (group 2, n=32). Baseline patient characteristics were similar except for worse New York Heart Association functional status and the prevalence of diabetes mellitus in group 1. In group 1, the operative, cross-clamp, and cardiopulmonary bypass times were shorter (all =0.001), postoperative drainage amounts were lower (=0.009), hospital stays were shorter (=0.004), and less red blood cell transfusion was needed (=0.037). Echocardiograms before patients' discharge from the hospital showed lower peak and mean aortic gradients in group 1 (mean transvalvular gradient, 8.4 ± 2.8 vs 12.2 ± 5.2 mmHg; =0.012). We found that elderly, high-risk patients who underwent multiple cardiac surgical procedures and sutureless AVR had better hemodynamic outcomes and shorter ischemic times than did patients who underwent conventional AVR.

In patients with respiratory failure and impairment of the left ventricle, arteriovenous extracorporeal membrane oxygenation (ECMO) offers further therapeutic options. Systemic anticoagulation is mandatory and heparin is routinely administrated. However, repeated exposure to heparin may cause heparin-induced thrombocytopenia (HIT) and carries a risk of thrombotic mortality and morbidity. We present a patient who developed HIT during ECMO support and was treated successfully and safely by fondaparinux. Fondaparinux can be used for thromboembolic treatment or prophylaxis in a patient with HIT.

BackgroundIn elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation.MethodsBetween October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used.ResultsThe mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%.ConclusionIn the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

Objective To compare immediate postoperative results in patients receiving heparin-albumin-coated and non-coated circuits. Methods A total of 241 patients undergoing on-pump cardiac surgery were divided into two groups: those receiving heparin-coated circuits (Bioline®, Maquet Cardiopulmonary AG., Hirrlingen, Germany) and those receiving non-coated circuits (Maquet Cardiopulmonary AG., Hirrlingen, Germany). Results Activated clotting times (ACT) during cardiopulmonary bypass (CPB) were significantly shorter in the heparin-albumin-coated group than in the non-coated group (355.64±34.12 vs. 560.38±90.20, respectively, P =0.001). In-hospital mortality and postoperative stroke rates and lengths of intensive care unit stay were similar between the groups; in contrast, in the heparin-albumin-coated group, patients had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion. Conclusion Heparin-coated circuits and reduced level of systemic heparinization with 300 seconds of target ACT level in cardiac surgery under CPB are safe and result in a very satisfactory clinical course.

Amaç: Tromboz, distal embolizasyon ve rüptür gibi semptomlara yol açabilen ya da asemptomatik olan popliteal arter anevrizmalarındaki cerrahi yaklaşımlarımızın erken ve geç dönem sonuçlarını karşılaştırdık.Gereç ve Yöntemler: Kliniğimizde Mart 2009 - Mart 2020 tarihleri arasında popliteal arter anevrizması nedeniyle cerrahi uygulanan 30 hastadaki 31 anevrizma çalışmaya dahil edildi. Popliteal anevrizma çapı 2 cm ve üzeri olan hastalar operasyona alındı. Hastalar greft açıklığı ve mortalite açısından takip edildi.Bulgular: Yaş ortalaması 69.66±12.18 olan hastaların %83.9 (n=26)’u erkek idi. Ortalama anevrizma çapı 47.53±19.59 mm olarak saptandı. Erken mortalite açısından iki yaklaşım arasında fark bulunamadı. Sağ kalım incelendiğinde ise bir ve beş yıllık sağ kalım posterior ve medial yaklaşımda sırasıyla %88, %58 ve %70, %63 idi. Ortalama sağ kalım süresi posterior yaklaşımda 72.39±11.66 ay iken medial yaklaşımda 75.83±16.07 ay idi. Her iki grup arasında uzun dönem sağ kalım bakımından fark yoktu (p=0.95). Uzun dönem greft açıklığı karşılaştırıldığında posterior ve medial yaklaşımlar için bir, beş ve dokuz yıllık açıklık oranları sırasıyla %75, %75, %54 ve %68, %58, %29 idi. İki grup arasında fark yoktu (p=0.46). Safen ven greftlerinin prostetik materyale göre daha uzun açık kaldığı gözlemlendi (p=0.047).Sonuç: Popliteal arter anevrizma cerrahisinde medial ve posterior yaklaşımlar arasında mortalite ve greft açıklığı bakımından fark olmamakla birlikte cerrahi yaklaşımdan bağımsız olarak safen ven greft açıklığı prostetik greftlere üstündür.

A good result in this case encourages us for one-stage combined surgical intervention in patients who require multisystem revascularization.

Common femoral artery aneurysms are uncommon and very rarely isolated. Here, we describe a large right femoral artery aneurysm that caused local discomfort and pain. A 60-yearold man was referred to an outpatient clinic of a cardiovascular surgery department. He had a 3-year history of a swelling in the right inguinal region and complained of its increasing size and worsening of pain. An examination of the right groin revealed a painless, pulsatile mass (5-7 cm in size). There was no history of hypertension, connective tissue disorder, Behcet's disease or any intervention in the right groin. Blood pressure was equal in both legs. Complete blood count and other blood test results were within normal limits. He had a smoking history of 25 packs/year. Duplex ultrasound of the mass revealed an aneurysm, measuring 35 × 38 mm, of the right common femoral artery. Computed tomography was performed, which showed a 33.5 mm aneurysm sac in a 5 cm segment (Figure 1). Surgery was performed under spinal anaesthesia. The aneurysm was dissected, and an 8-mm Dacron graft was interposed (Figures 2A and B). The patient was discharged on the postoperative day 2. He had an uneventful recovery, with no complications found at his 1-week postoperative follow-up.