Background: The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. Methods: In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value.

BackgroundRedo-sternotomy for mitral valve (MV) surgery may be complex and attendant complications can be avoided using anterolateral right thoracotomy, deep hypothermia (20°C, nasopharyngeal) with low flow cardiopulmonary perfusion. Video-assisted minithoracotomy technique is a further improvement.MethodsWe performed 20 consecutive MV operations in patients with previous cardiac surgery using video-assisted right minithoracotomy, femoro-femoral bypass, deep hypothermia, low flow cardiopulmonary bypass without aortic cross-clamping. The mean follow-up was 30 ± 17.8 mo. Data is presented as the mean ± standard deviation of the mean.ResultsThere were 11 males and 9 females (age, 62.3 ± 12.1; ejection fraction 50.1 ± 11.2). Operations included MV replacement (n = 11), MV repair (n = 5), and MV re-replacement (n = 4). There were no hospital deaths, and the mean hospital stay was 8 ± 2.9 days. There were no postoperative strokes or need for mechanical circulatory support. The mean cardiopulmonary bypass time was 152 ± 28 minutes. Two patients (10%) required inotropic support beyond 24 hrs. All patients were free from inotropic support at 48 hours. The mean number of transfused red cell units was 2.8 ± 0.8 (range, 2 to 4). One patient died in another institution six months postoperatively following surgery for acute type III aortic dissection. At 30 ± 17.8 months follow-up all patients were found to be in NYHA Class I or II.ConclusionsMinimally invasive video-assisted MV surgery using deep hypothermia, low-flow cardiopulmonary bypass without aortic clamping can result in excellent clinical outcomes in patients with previous cardiac surgery via a median sternotomy. This technique offers reproducible results, good myocardial protection (as evidenced by the low rate of inotropic support that patients needed postoperatively), and low rates of complications.

IntroductionDetermining operative mortality risk is mandatory for adult cardiac surgery. Patients should be informed about the operative risk before surgery. There are some risk scoring systems that compare and standardize the results of the operations. These scoring systems needed to be updated recently, which resulted in the development of EuroSCORE II. In this study, we aimed to validate EuroSCORE II by comparing it with the original EuroSCORE risk scoring system in a group of high-risk octogenarian patients who underwent coronary artery bypass grafting (CABG).Material and methodsThe present study included only high-risk octogenarian patients who underwent isolated coronary artery bypass grafting in our center between January 2000 and January 2010. Redo procedures and concomitant procedures were excluded. We compared observed mortality with expected mortality predicted by EuroSCORE (logistic) and EuroSCORE II scoring systems.ResultsWe considered 105 CABG operations performed in octogenarian patients between January 2000 and January 2010. The mean age of the patients was 81.43 ± 2.21 years (80-89 years). Thirty-nine (37.1%) of them were female. The two scales showed good discriminative capacity in the global patient sample, with the AUC (area under the curve) being higher for EuroSCORE II (AUC 0.772, 95% CI: 0.673-0.872). The goodness of fit was good for both scales.ConclusionsWe conclude that EuroSCORE II has better AUC (area under the ROC curve) compared to the original EuroSCORE, but both scales showed good discriminative capacity and goodness of fit in octogenarian patients undergoing isolated coronary artery bypass grafting.

Bu çalışmada median sternotomi ile açık kalp cerrahisi yapılan, Vücut Kütle İndeksi ≥30 kg/m 2 olan hastalarda Jackson-Pratt dreninin sternal yara komplikasyonları üzerindeki etkisi incelendi. Ça lış mapla nı:Ocak 2011-Aralık 2015 tarihleri arasında Vücut Kütle İndeksi ≥30 kg/m 2 olan, hastanemizde median sternotomi ile açık kalp cerrahisi yapılan toplam 174 hasta (124 erkek, 50 kadın; ort. yaş 58.2±10.4 yıl; dağılım, 33-78 yıl) retrospektif olarak incelendi. Hastaların 94'üne median sternotomi sonrası Jackson-Pratt dreni takılırken (JP grubu), 80 hastaya dren takılmadı (JP olmayan grup). Her iki grubun ameliyat tipi, hastanede kalış süresi ve komplikasyonlar dahil olmak üzere ameliyat öncesi, sırası ve sonrası sonuçları karşılaştırıldı. Bul gu lar: Gruplar arasında yaş, cinsiyet, Vücut Kütle İndeksi ve muhtemel risk faktörleri arasında anlamlı bir fark yoktu. Her iki grupta da yoğun bakım ünitesinde median kalış süresi iki gün ve ameliyattan taburculuğa kadar geçen median süre yedi gündü. Gruplar arasında sternal yara komplikasyon oranı açısından istatistiksel olarak anlamlı bir fark bulundu. Dren takılmayan grupta dokuz hastaya (%11.25) kıyasla, dren takılan grupta iki hastada (%2.1) sternal yara komplikasyonu gelişti (p= 0.01). So nuç: Çalışma bulgularımız, median sternotomi sonrasında Jackson-Pratt dren kullanımının vücut kitle indeksi ≥30 kg/m 2 olan, açık kalp cerrahisi yapılan hastalarda geleneksel kapatma tekniğine kıyasla, ameliyat sonrası sternal yara komplikasyon riskini azaltmada basit ve güvenli bir yöntem olduğunu göstermektedir. Anah tar söz cük ler: Jackson-Pratt dreni; median sternotomi; sternal yara komplikasyonları.

Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair? Objective: Trans-apical off-pump mitral valve repair is a new minimally invasive surgical technique for the correction of mitral regurgitation caused by mitral leaflet prolapse. The purpose of this study is to evaluate, using clinical and echocardiographic follow-up data, the mid-term results of patients undergoing this procedure. Methods: A total of 26 patients diagnosed with severe mitral regurgitation underwent mitral valve repair with trans-apical off-pump neochord implantation using the NeoChord device at our hospital from July 2015 to July 2017. All patients were examined by transthoracic and transesophageal echocardiography. Eighteen (69.2%) patients had type A anatomy, 4 (15.4%) had type B anatomy, and 4 (15.4%) had type C anatomy. Preoperative, intraoperative, and postoperative demographic, echocardiographic, and clinical data were collected. Results: The patients' age ranged from 33 to 76 years (mean: 56±10.1 years). The average preoperative EuroSCORE II was 1.04%±0.7%. Acute procedural success was achieved in 25 (96.15%) patients. There was only 1 early death (30-day mortality rate: 3.8%) due to postoperative low cardiac output syndrome. Transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation in 87.5% of the patients and moderate regurgitation in 12.5% of the patients. During the follow-up period, transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation (MR) in 14 (58.3%) patients. Six (25%) patients presented with moderate MR and 4 (16.7%) patients had severe MR. At the 30-month follow-up, freedom from residual severe MR was 78.8%±10.3% and freedom from reoperation was 87.5%±6.8%. Conclusion: Trans-apical off-pump mitral valve repair with neochord implantation may be a suitable treatment option in patients with isolated posterior mitral valve leaflet prolapse.

Bu çalışmada farklı etiyolojileri olan hastalarda mitral kapak onarımının klinik sonuçları sunuldu. Ça lış mapla nı:Haziran 2006-Ağustos 2017 tarihleri arasında eş zamanlı kardiyak ameliyat ile birlikte veya tek başına mitral kapak onarımı yapılan toplam 421 ardışık hasta (266 erkek, 155 kadın; ort. yaş 53.1±15.6 yıl; dağılım, 5-89 yıl) retrospektif olarak incelendi. Tüm ameliyat öncesi, sırası ve sonrası veriler toplandı. Ekokardiyografik incelemeler taburculukta ve takip sırasında yapıldı. Kaplan-Meier analizi genel sağkalım ve rezidüel ciddi mitral yetmezlik, endokardit ve tekrar ameliyatsız sağkalım oranlarının tahmininde kullanıldı. Bul gu lar: Ortalama takip süresi 58.9±35.1 ay idi. Hastaların 12'si (%2.8) daha önce kalp ameliyatı geçirmişti. En yaygın patoloji 265 hastada (%62.9) dejeneratif hastalık idi. Onarım teknikleri ring anüloplasti (n=366, %86.9), yapay korda implantasyonu (n=185, %44) ve komissürotomi (n=38, %9) idi. Genel olarak hastane mortalitesi %1.2 (n=5) idi. Taburculuk öncesinde ekokardiyografide hastaların %64.9'unda (n=270) mitral yetmezlik izlenmedi veya önemsiz mitral yetmezlik izlendi ve hastaların %34.85'inde (n=145) hafif mitral yetmezlik izlendi. Ameliyat sonrası geç dönemde, transtorasik ekokardiyografide 23 hastada (%5.7) orta dereceli ve 11 hastada (%2.7) ciddi mitral yetmezlik izlendi. Ortalama geç sağkalım, endokardit, yeniden ameliyat ve tekrarlayan ciddi mitral yetmezlikten bağımsızlık oranı sırasıyla %92±0.03, %98.5±0.07, %98.1±0.01 ve %94.7±0.02 idi. So nuç:Çalışma sonuçlarımız mitral kapak onarımının deneyimli merkezlerde uzun dönem olumlu sonuçlar ile ilişkili olarak, güvenli ve etkin bir yöntem olduğunu göstermektedir. Anah tar söz cük ler: Mitral yetmezlik, mitral darlık, mitral kapak anüloplastisi.

Introduction: The aim of this study is to investigate whether macrophage migration inhibitory factor (MIF) predicts the prognosis of COVID-19 disease. Methodology: This descriptive and cross-sectional study was conducted on 87 confirmed COVID-19 patients. The patients were separated into two groups according to the admission in the ICU or in the ward. MIF was determined batchwise in plasma obtained as soon as the patients were admitted. Both groups were compared with respect to demographic characteristics, biochemical parameters and prediction of requirement to ICU admission. Results: Forty seven patients in ICU, and 40 patients in ward were included. With respect to MIF levels and biochemical biomarkers, there was a statistically significant difference between the ICU and ward patients (p< 0.024). In terms of ICU requirement, the cut-off value of MIF was detected as 4.705 (AUC:0.633, 95%CI:0.561-0.79, p= 0.037), D-dimer was 789 (AUC:0.779, 95%CI: 0.681-0.877, p= 0.000), troponin was 8.15 (AUC: 0.820, 95%CI:0.729-0.911, p= 0.000), ferritin was 375 (AUC: 0.774, 95%CI:0.671-0.876, p= 0.000), and lactate dehydrogenase (LDH) was 359.5 (AUC:0.843, 95%CI: 0.753-0.933, p= 0.000). According to the logistic regression analysis; when MIF level > 4.705, the patient’s requirement to ICU risk was increased to 8.33 (95%CI: 1.73-44.26, p= 0.009) fold. Similarly, elevation of troponin, ferritin and, LDH was shown to predict disease prognosis (p< 0.05). Conclusions: Our study showed that MIF may play a role in inflammatory responses to COVID-19 through induction of pulmonary inflammatory cytokines, suggesting that pharmacotherapeutic approaches targeting MIF may hold promise for the treatment of COVID-19 pneumonia.

Brucellosis is a zoonotic disease common in developing countries. Vascular complications, including arterial and venous, associated with Brucella infection have rarely been reported. A case of deep venous thrombosis (DVT) developing after a diagnosis of acute brucellosis in a young milkman is presented. A 26-year-old man presented with pain in the right leg. The patient's medical history included a diagnosis of brucellosis in our hospital where he had presented with complaints of weakness and fever. Peripheral venous Doppler ultrasound showed DVT, and the patient was treated with anticoagulants. The patient was discharged with warfarin therapy and anti-brucellosis treatment. Although rare, some infectious agents may cause vascular pathologies. Patients presenting with symptoms of DVT or similar vascular pathologies should be assessed for infectious agents, particularly in those coming from Brucella-endemic areas.