The results of this study clearly demonstrated that a minimally invasive approach using robotic-assisted surgery has advantages in terms of body image, self-esteem, and cosmetic outcomes over the conventional approach in patients undergoing cardiac surgery.
Background: Neutrophil to lymphocyte ratio (NLR) is a prognostic predictor in a wide range of cardiovascular disease. Acute aortic dissection (AD) is an uncommon but fatal cardiovascular disease. In this study, we investigated both prognostic factors in patients with AD and whether NLR can be a predictor for mortality. Methods: We analyzed retrospectively the data of 57 patients with AD who had undergone emergent surgery in our hospital and included 128 consecutive patients with chest pain admitted to the emergency room as a control group. Also, patients who were operated on due to aortic dissection as another subgroup were compared to NLR values. Baseline clinical features, cardiovascular risk factors, and surgical and laboratory parameters were obtained from the hospital database. Results: Patients with AD had higher NLR than the control group (1.7 ± 0.5 versus 7.6 ± 3.3, P < .001). In the AD group, 15 deaths occurred and non-survivors had significantly higher NLR, compared to survivors (11.6 ± 2.4 versus 6.6 ± 2.3, P < .001). In multivariate analysis, high NLR (odds ratio [OR] 1.913, 95% CI 1.030-1.081, P = .04) and cross-clamp time (OR 1.265, 95% CI 1.003-1.596, P = .04) were determined as independent predictors of in-hospital mortality. In receiver operating characteristics curve analyses, the NLR > 9.3 predicted the mortality in AD with a specificity of 91% and a sensitivity of 86% (P < .001).Conclusion: This study shows that high NLR can be used as a marker for prognosis in short-term mortality of patient with AD. Additionally, increased lactate level in perioperative period, prolonged cardiopulmonary bypass time, and additional cardiac procedures are strong independent predictors of short-term mortality in patients with acute AD.
IntroductionPericardial effusion and atrial fibrillation occur commonly after coronary artery surgery.Aim of the studyA prospective randomized clinical trial was conducted to evaluate the effects of posterior pericardiotomy on the occurrence of pericardial effusion, tamponade, and atrial fibrillation.Material and methodsThe study group consisted of 96 patients (77 male and 19 female) at a mean age of 58.1 ± 9.8 years. The patients were randomly assigned to one of three study groups: patients undergoing posterior pericardiotomy (group I, n = 30), controls (group II, n = 33), and patients with additional posterior pericardial drainage tubes (28 mm) who did not undergo posterior pericardiotomy (group III, n = 33).ResultsPostoperative hospitalization (p = 0.03; 11.56 ± 10.64) and reoperation due to tamponade (p = 0.019; 12.1%) were significantly higher in group II. Extensive pericardial effusions were detected in one patient on the first postoperative day (group II, n = 1), in one patient on the fifth postoperative day (group III, n = 1), and in one patient on the 30th day after the operation (group III, n = 1). Pericardial effusion exhibited regression in group I on postoperative day 30 (p = 0.028). A higher rate of postoperative atrial fibrillation was noted in group I, but no significant differences were found between the groups with regard to postoperative atrial fibrillation.ConclusionsPatients who did not undergo posterior pericardiotomy or did not receive posterior chest tubes exhibited residual pericardial effusion, required longer hospitalization, and had to be reoperated due to tamponade. Both posterior pericardiotomy and the use of posterior tubes are effective in the early postoperative period.
To investigate the association between clinical hematologic parameters and
saphenous vein graft failure after on-pump coronary artery bypass
A total of 1950 consecutive patients underwent isolated on-pump coronary
artery surgery between November 2010 and February 2013. Of these, 284
patients met our inclusion criteria; their preoperative clinical
hematological parameters were retrospectively obtained for this cohort
study. And of them, 109 patients underwent conventional coronary angiography
after graft failure was revealed by coronary computed tomography
angiography. The primary endpoint was to catch at least one saphenous vein
graft stenosis or occlusion following the coronary angiogram. We then
analyzed risk factors for graft failure. In sequential or T grafts, each
segment was analyzed as a separate graft.
In logistic regression analysis, older age, platelet distribution width, and
diabetes mellitus were identified as independent predictors of saphenous
vein graft failure (
<0.). In contrast, preserved
ejection fraction value favored graft patency
Increased platelet distribution width is easily measurable and can be used as
a simple and valuable marker in the prediction of saphenous vein graft
Background: This study aims to investigate possible risk factors with the morbidity and mortality rates in women and men under the age of 45 undergoing coronary artery bypass graft (CABG) surgery. Methods: Between August 2009 and May 2012, a total of 230 patients (189 males, mean age 41.4±3.4 years; range 35 to 45 years; 41 females, mean age 41.9±3.0; range 32 to 45 years) under the age of 45 who underwent CABG in our clinic were included. Patients were divided into two groups according to their gender and a comparative analysis was performed. Results: The mean age was 41.9 years (range, 32 to 45 years) in women and 41.4 years (range, 35 to 45 years) in men. Unstable angina pectoris (p<0.001), hypertension (p<0.001), dyslipidemia (p=0.009) ischemic mitral regurgitation (p=0.03), mitral valve annuloplasty (p=0.03), postoperative atrial fibrillation, (p=0.031) and wound infections (p<0.001) were statistically significant with female gender. Syntax score (p<0.001), smoking (p=0.002), chronic obstructive pulmonary disease (p<0.001), number of distal anastomoses (p<0.001), ejection fraction (p<0.001) were statistically significant associated with male gender. In-hospital mortality rates were similar in men and women. There was no significant difference in the early-and midterm survival rates of female and male patients following surgery. The mean postoperative follow-up was 18.2±9.5 months in women and 31.6±19.3 months in men. Conclusion: Our study results suggest that the incidence of traditional risk factors including dyslipidemia and hypertension is higher in women.
The cardiac involvement of hydatid cyst, which is rarely seen, with the location of asymptomatic huge cyst in the interventricular septum (IVS) is an extraordinary condition. We report an isolated cardiac hydatid cyst located in the IVS in an 18-year-old man diagnosed incidentally by transthoracic echocardiography. Cardiac magnetic resonance imaging confirmed a mass lesion of 47×74 mm in diameter located at the base of IVS. The cystic content and its germinative membrane were resected and the cavity was applicated under cardiopulmonary bypass. Postoperative course was uneventful and the patient was discharged on the 6 th postoperative day, with oral albendazole therapy.
A 17-year-old female patient with a history of surgery for primary femoral and metastatic lung osteosarcoma was admitted to our clinic with palpitations. Upon evaluation, a metastatic osteosarcoma in the left ventricle was diagnosed. Based on the collaborative decision of the oncology and cardiovascular surgery clinics, surgery was performed and the patient was discharged without any problems. According to the recommendation of the oncology clinic, chemotherapy was postponed for 6 months after surgery. Five months postoperatively, however, she had a recurrence with 2 tumors. Based on the collaborative decision, chemotherapy was initiated and in 2 months the size of the recurrent tumors had diminished. The patient is still under the care of the oncology and cardiovascular surgery clinics and continuing her chemotherapy regimen. Osteosarcomas have a high mortality. Metastatic tumors of the heart are not common. The location of the metastasis and the characteristics of the primary tumor determine the treatment modality. In some previously published reports, various treatment choices have been described. In the present case report, we present a rare case with metastatic cardiac osteosarcoma.
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