Objectives: Main goal of coronary bypass surgery is complete revascularization. In some coronary endarterectomy applied patient groups, complete revascularization is inevitable. In this study, it was aimed to reveal factors affecting early mortality and morbidity in patients undergoing coronary endarterectomy. Methods: Retrospective records of preoperative, operative, and postoperative data of 98 patients undergoing coronary artery bypass grafting (CABG) with coronary endarterectomy between January 1, 2012, and October 30, 2016, were reviewed. Results: A total of 113 endarterectomies were performed in different coronary arteries. Of the patients, 22 (22.4%) were female and 76 (77.6%) were male. The mean of ages was 60.4 ± 9.9 (range; 36-81 years). A positive inotropic requirement was required in 68 (69.1%) patients and intra-aortic balloon pump was required for 23 (23.4%) patients. Mortality was observed in 10 patients (10.2%). Peroperative myocardial infarction was observed in 17 (17.3%) patients. Mortality rate was significantly higher in patients whose left ventricular ejection fraction was 30 or less and who had a higher risk in EuroSCORE (p < 0.001). When compared with the other vessels, mortality ratewas found to be higher for left anterior descending coronary artery endarterectomy (p = 0.038). Mortality in female patients undergoing endarterectomy was higher than male patients (p = 0.023). Conclusions: Mortality and morbidity are higher in patients undergoing coronary endarterectomy when compared to conventional CABG operations. However, it is a method that can be applied by considering certain risk factors.

Amaç: Aortik diseksiyon günümüzde hala önemli bir mortalite ve morbidite nedenidir. Tip A aort diseksiyonu nedeniyle ameliyat edilen hastalarda birçok faktör cerrahi sonuçları etkilemektedir. Bu faktörlerin yeterince belirlenmesi tedavinin başarılı olmasına etki edecektir. Yöntemler: Kliniğimizde Ocak 2006-Aralık 2016 yılları arasında Tip A aort diseksiyonu tanısı ile opere edilen 140 hastanın preoperatif, intraoperatif, ve postoperatif verileri, hasta dosyaları ve hastane bilgi yönetim sistem kayıtlarından retrospektif olarak araştırıldı. Gruplar arası niceliksel parametreler Student t veya Mann-Whitney U testleri ile, niteliksel veriler ise Ki-Kare testi ile karşılaştırıldı. Mortalite olan hastalarda perfüzyon süreleri uzun, inotrop ihtiyacı fazla, yoğun bakım yatış süreleri istatiksel olarak anlamlı derecede yüksekti (p<0.05). RSP yapılan grupta yoğun bakımda kalış süreleri ve mortalite, ASP uygulanan hastalara göre anlamlı oranda yüksekti (sırası ile p=0.02, p=0.04). Sonuç: Tip A aortik diseksiyonlarda mortalite üzerine etki eden faktörlerin daha büyük hasta serilerinde ortaya konulması ve bu faktörlere yönelik tedbirlerin alınması mortalite ve morbiditenin azaltılmasında etkili olabilir.

INTRODUCTION: Atrial fibrillation (AF) after coronary artery bypass surgery (CABG) is the most common type of arrhythmia and it causes serious morbidity. Low levels of triiodothyronine (T3) hormone are thought to be a strong determinative factor on poor prognosis of cardiac patients. This study was planned to investigate the effect of low levels of T3 on the development of AF after off-pump coronary artery bypass surgery (OPCAB) and conventional CABG surgery. METHODS: The study was prospectively planned on 60 patients undergoing CABG surgery. Thirty of them were randomly selected among the patients undergoing OPCAB, and the other 30 were randomly selected among the patients undergoing conventional CABG surgery. Thyroid function profiles of all patients were evaluated before the operation and on the first day of postoperative period. RESULTS: The average age of the patients was 58.7± 8. After the operation, 3 patients from each group, 6 patients in total, developed AF. Postoperatively measured TT3 levels of the patients who developed AF after the operation (0.39±0.09) were found to be significantly lower than the preoperatively measured TT3 levels (0.97± 0.06) (p=0.042). Moreover, postoperatively measured fT3 levels of the patients who developed AF after operation (1.58± 0.30) were found to be significantly lower than the preoperatively measured fT3 levels (2.95±0.37) ( p=0.001). However, by univariate logistic regression analysis, it was seen that the variables that were thought to be risk factors for AF were not significantly effective. Also, when the effects of the variables were examined together by multivariate regression analysis, no significant result was found. DISCUSSION AND CONCLUSION: In our study, it was seen that low levels of thyroid hormone in patients undergoing OPCAB and conventional CABG surgery had no effect on AF development

We read the article [1] and congratulate the authors for this successful treatment. On the other hand, we would like to clarify some points about the treatment of this patient.It is understood from the article that the patient was already intubated before the endovascular procedure and bilateral femoral embolectomy could be also easily done urgently. [2] Thrombolysis and thrombus aspiration could have been used as an appropriate treatment for this patient with saddle embolism. [3] In this case, thrombolytic therapy could be considered before the thrombus aspiration or endovascular intervention. In addition, all femoropopliteal-tibioperoneal arterial structures should be scanned after the procedure. We are curious about your valuable comments about our contribution.

In most adult cardiac surgery operations, the heart must be completely immobile and isolated from the blood. Therefore, the heart is stopped in diastole and a still operative site is obtained. Cardiac arrest results in ischemiareperfusion injury. For these reasons, myocardial protection and the prevention of damages are required. Various cardioplegia solutions are used for this purpose. It can be said that cardioplegia is the gold standard method of myocardial protection in cardiac arrest. Nowadays, "Single-dose cardioplegia" applications are increasingly used, especially in minimally invasive cardiac surgery and basic coronary bypass procedures due to the advantages they provide, which include reduction of aortic cross-clamp time, prevention of frequent interruption of the procedure due to cardioplegia, and reduced postoperative myocardial dysfunction incidence. The two main solutions used in single dose cardioplegia applications are the Bretschneider solution and the del Nido extracellular cardioplegia solution. The del Nido cardioplegia solution (dNCS), which was originally developed for use in pediatric cardiac surgery, has recently increased its use in adult cardiac surgery due to straightforward application and long-term effectiveness. The del Nido cardioplegia reduces the aortic cross clamp duration, cardiopulmonary bypass time and required cardioplegia solution volume, and is a safer and superior cardioplegia solution and technique in terms of myocardial protection with regards to many organs and cardiacbiochemical parameters.