No abstract

No abstract

Background: We aimed to investigate the predictive value of Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE II) scores for mortality in octogenarian cardiac surgery patients. Methods: Between January 2016 and December 2019, cardiac operations performed in 116 octogenarian patients (73 males, 43 females; mean age: 82.9±3.1 years; range, 80 to 97 years) were retrospectively analyzed. The patients with and without mortality were compared for their demographic and operative factors. The STS and EuroSCORE II scores, and observed mortality rates were assessed. Results: Mean STS score was 3.7±11.1 and mean EuroSCORE II was 5.2±5.4. For any operation type, the mean EuroSCORE II was significantly higher (8.1±7.4 vs. 4.1±4.0, respectively; p=0.006) in the patients with mortality. For elective operations, the mean EuroSCORE II was higher in cases with mortality (7.2±7.3 vs. 3.7±3.9, respectively; p=0.006); however, for urgent cases, there was no significant difference between the scores. Using the receiver operating characteristic curve, the EuroSCORE II had a higher area under the curve for all cases and elective cases than the STS scores. Conclusion: The EuroSCORE II performed better than the STS score for mortality prediction in octogenarians, whereas the predictions of either scoring system was unsatisfactory for urgent surgery and combined procedures. Population-based validation studies are needed for a better risk scoring system in this age group.

True radial artery aneurysms are uncommon pathologies and have an organic cause, unlike trauma-induced false aneurysms. A 52-year-old man presented with a pulsatile mass at the anatomical snuff box area of his left hand. The aneurysm was repaired with reconstructive procedure. Although many posttraumatic and iatrogenic cases of false aneurysm of the radial artery have been reported; there are a few reported cases of a true idiopathic aneurysm. A case of reconstructive surgery for true idiopathic radial artery aneurysm is reported in this paper.

Objectives Inflammation is a component in the pathogenesis of critical limb ischemia. We aimed to assess how inflammation affects response to treatment in patients treated for critical limb ischemia using neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocytes ratios (PLR) as markers of inflammation. Methods Patients in a single tertiary cardiovascular center with critical limb ischemia unsuitable for surgical or interventional revascularization were retrospectively identified. Data were collected on medical history for risk factors, previous surgical or endovascular revascularization, and outcome. A standard regimen of low molecular weight heparin, aspirin, statins, iloprost infusions, and a standard pain medication protocol were applied to each patient per hospital protocol. Patients with improvement in ischemic pain and healed ulcers made up the responders group and cases with no worsening pain or ulcer size or progression to minor or major amputations made up the non-responders group. Responders and Non-responders were compared for risk factors including pretreatment NLR and PLR. Results 268 included patients who were not candidates for surgical or endovascular revascularization were identified. Responders had significantly lower pretreatment NLR (4.48 vs 8.47, p < 0.001) and PLR (162.19 vs 225.43, p = 0.001) values. After controlling for associated risk factors NLR ≥ 4.63 (p < 0.001) and PLR ≥ 151.24 (p = 0.016) were independently associated with no response to treatment. Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocytes ratio are markers of inflammation that are reduced in patients improving with medical treatment suggesting a decreased state of inflammation before treatment in responding patients.

Bu çalışmada postkardiyotomik şok nedeniyle ekstrakorporeal membran oksijenasyon desteği alan hastalarda nötrofil-lenfosit oranı ve böbrek hasarı arasındaki ilişki araştırıldı. Ça lış ma pla nı: Ocak 2007 -Temmuz 2018 tarihleri arasında merkezimizde postkardiyotomik şok nedeniyle ekstrakorporeal membran oksijenasyon desteği alan ve en az 48 saat hayatta kalan toplam 119 hasta (38 erkek, 81 kadın; ort. yaş 54.4±13.0 yıl; dağılım 24-74 yıl) retrospektif olarak incelendi. Hastaların ameliyat öncesi ve sonrası nötrofil-lenfosit oranları, demografik özellikleri, böbrek fonksiyon parametreleri ve ekstrakorporeal membran oksijenasyona ilişkin verileri kaydedildi. Böbrek hasarının gelişimi ve evreleri revize Akut Böbrek Hasarı Ağı ve Böbrek Hastalığında Küresel Sonuçların İyileştirilmesi kriterlerine göre belirlendi. Bul gu lar: Ameliyat öncesi nötrofil-lenfosit oranı ve böbrek hasarı arasında anlamlı bir ilişki saptanmadı (p>0.05). Ameliyat sonrası nötrofil-lenfosit oranı, böbrek hasarı gelişen hastalarda, böbrek hasarı olmayan hastalara kıyasla, daha yüksekti (sırasıyla 8.68 [0.84-42.00] ve 4.02 [1.04-21.21], p= 0.004). Hastalar Akut Böbrek Hasarı Ağı (p= 0.015) ve Böbrek Hastalığında Küresel Sonuçların İyileştirilmesi (p= 0.006) kriterlerine göre böbrek hasarı evrelerine ayrıldıklarında, daha ciddi böbrek hasarı olan hastalarda nötrofil-lenfosit oranı daha yüksek bulundu. Alıcı işletim karakteristik analizi ile böbrek hasarı tespitinde nötrofil-lenfosit oranının kesim değeri 6.71 olarak saptandı. 6.71'in üzerinde bir değere sahip hastalarda, böbrek hasarı gelişiminin olasılık oranı 5.941 idi. So nuç: Ameliyat öncesi değil fakat, ameliyat sonrası nötrofillenfosit oranı, postkardiyotomik şok nedeniyle ekstrakorporeal membran oksijenasyon desteği alan hastalarda böbrek hasarının varlığı ve derecesi ile ilişkilidir. Nötrofil-lenfosit oranı, bu hasta grubunda basit ve ucuz bir enflamasyon belirtecidir. Anah tarsöz cük ler: Ekstrakorporeal membran oksijenasyonu, enflamasyon, nenötrofil-lenfosit oranı, postkardiyotomik şok, böbrek hasarı.

Introduction Vasoplegia denotes a state of low tissue perfusion characterized by hypotension, tachycardia, and low systemic vascular resistance. This state results in increased mortality and morbidity following cardiac surgery. A better understanding of the associated risk factors will guide the surgical team in patient management. The aim of this study is to determine which risk factors are involved in its emergence. Methods This prospective observational study included adult cardiac surgery patients between February ‐ September 2018 at a single cardiothoracic surgery center. Patients were evaluated for cardiac contractility, surgical drainage, inotrope, and vasopressor requirement perioperatively. The groups were compared for demographic, echocardiographic, and operative variables. Variables significant in univariate analysis were carried on to binary logistic regression for risk factor analysis. Results A total of 31 patients were vasoplegic among a total of 487 included patients, resulting in a 6.37% incidence. In the vasoplegia group, chronic kidney failure, use of angiotensin‐converting enzyme (ACE) inhibitors, use of angiotensin receptor blockers, and use of diuretics were more frequent, cardiopulmonary bypass (CPB) and aortic cross‐clamp durations were longer, and mean Euroscore II was higher. Vasoplegia was more frequent in valve surgery and resternotomy patients. CPB duration, use of ACE inhibitors, use of angiotensin receptor blockers, and chronic renal failure were independent risk factors. Conclusion Patients with long CPB duration, preoperative use of ACE inhibitors or Angiotensin receptor blockers, and a history of renal failure requiring dialysis are under increased risk of vasoplegia. Vasoplegia necessitates large‐scale studies for a better understanding of its risk factors.

No abstract