Surgical treatment for RSVA carries an acceptably low operative risk and long-term freedom from death and reoperation. Surgical approach must be chosen according to the ruptured chamber and associated lesions. Patch repair of RSVA must be preferred.

Low IL-18 and NGAL levels found in the pulsatile perfusion group might suggest the use of pulsatile flow resulted in better kidney protection.

ObjectiveThis study aims to compare three different surgical approaches for combined coronary and carotid artery stenosis as a single stage procedure and to assess effect of operative strategy on mortality and neurological complications.MethodsThis retrospective study involves 136 patients who had synchronous coronary artery revascularization and carotid endarterectomy in our institution, between January 2002 and December 2012. Patients were divided into 3 groups according to the surgical technique used. Group I included 70 patients who had carotid endarterectomy, followed by coronary revascularization with on-pump technique, group II included 29 patients who had carotid endarterectomy, followed by coronary revascularization with off-pump technique, group III included 37 patients who had coronary revascularization with on-pump technique followed by carotid endarterectomy under aortic cross-clamp and systemic hypothermia (22-27ºC). Postoperative outcomes were evaluated.ResultsOverall early mortality and stroke rate was 5.1% for both. There were 3 (4.3%) deaths in group I, 2 (6.9%) deaths in group II and 2 (5.4%) deaths in group III. Stroke was observed in 5 (7.1%) patients in group I and 2 (6.9%) in group II. Stroke was not observed in group III. No statistically significant difference was observed for mortality and stroke rates among the groups.ConclusionWe identified no significant difference in mortality or neurologic complications among three approaches for synchronous surgery for coronary and carotid disease. Therefore it is impossible to conclude that a single principle might be adapted into standard practice. Patient specific risk factors and clinical conditions might be important in determining the surgical tecnnique.

AimThe aims of this study were to determine the early mortality rate in low-risk coronary artery bypass graft (CABG) patients and examine the causes of death, to identify problems that could be avoided in future surgeries.MethodsAll low-risk patients (EuroSCORE ≤ 2) who died after CABG were included. Their peri-operative information was meticulously studied by internal and independent external reviewers to identify causes of death, which were classified as: cardiac or non-cardiac; and a further division as: (1) non-preventable, (2) preventable (technical error), and (3) preventable (system error).ResultsEarly mortality was 0.93% (24/2 570). Eleven patients (45.8%) were classified as preventable deaths. In six of them the main problem was identified as graft thrombosis, which was secondary to a technical error of either the harvesting or anastomosis of the left internal mammarian artery. There were also five system errors identified as delays in the treatment of an identified and potentially reversible problem.ConclusionsCorrection of technical and system errors, such as harvesting of the left internal mammarian artery, haemostasis during surgery, and establishing standard protocols for the transfer of patients from ward to intensive care units will eventually lead to improvement in both the quality of care and patient outcomes, even in low-risk groups.

Bu çalışmada diabetes mellituslu hastalarda koroner anjiyografi ve koroner arter baypas greftleme arasında geçen zamanın ameliyat sonrası akut böbrek hasarı üzerindeki etkisi araştırıldı. Ça lış ma pla nı:Aralık 2013 -Kasım 2016 tarihleri arasında koroner arter baypas greftleme yapılan toplam 421 hasta (274 erkek, 147 kadın; ort. yaş 60±9.2 yıl; dağılım 31-84 yıl) çalışmaya alındı. Hastaların demografik özellikleri, eşlik eden hastalıkları, tıbbi ve cerrahi öyküleri, daha önce yapılan koroner anjiyografileri ve cerrahi ve laboratuvar sonuçları dahil olmak üzere veriler retrospektif olarak incelendi. Hastalar akut böbrek hasarı olanlar (n=108) ve akut böbrek hasarı olmayanlar (n=313) olmak üzere iki gruba ayrıldı. Akut böbrek hasarı, Risk, Hasar, Yetmezlik, Kayıp, Son Dönem Böbrek Hastalığı (RIFLE) kriterlerine göre tanımlandı. Ayrıca hastalar zaman aralığına göre üç alt gruba ayrıldı: 0-3 gün, 4-7 gün ve >7 gün. Bul gu lar: Koroner anjiyografi ve koroner arter baypass greftleme arasında geçen medyan süre açısından akut böbrek hasarı olan ve olmayan hastalar arasında istatistiksel olarak anlamlı bir fark yoktu (sırasıyla, 11.5 ve 12.0 gün; p= 0.871). Akut böbrek hasarı risk faktörleri açısından alt gruplar arasında anlamlı bir fark yoktu. Çok değişkenli analizde geçirilmiş miyokard enfarktüsü (olasılık oranı [OR]: 5.192, %95 güven aralığı [GA]: 2.176-12.38; p<0.001) ve ameliyat sonrası birinci gün kreatinin düzeylerindeki artışın [OR: 4.102, %95 GA: 1.278-13.17; p= 0.018) akut böbrek hasarının bağımsız belirleyicileri olduğu bulundu. So nuç:Diabetes mellituslu hastalarda koroner anjiyografiden sonra, akut böbrek hasarı riskinde artış olmaksızın, herhangi bir gecikme olmadan koroner arter baypas greftleme yapılabilir. Anah tar söz cük ler: Akut böbrek hasarı; koroner anjiyografi; koroner arter baypas greftleme; diabetes mellitus.

SummaryIntroduction:Coronary artery bypass grafting (CABG) results in higher morbidity and mortality rates in end-stage renal disease (ESRD) patient populations than in patients with normal renal function. This study aimed to identify the early results of CABG performed on ESRD patients, and the factors that affected the mortality rates of those patients.Methods:A retrospective evaluation of our hospital database revealed 84 haemodialysis-receiving patients who underwent CABG during the years 2006 to 2012. Mortality was observed in 21 patients (group 1), and this group was compared with the remaining patients (group 2) for peri-operative parameters such as age, EuroSCORE, functional capacity, myocardial infarction, use of inotropes and completeness of revascularisation.Results:The study included 60 male (71.4%) and 24 female patients (28.6%); the participants’ mean age was 59.50 ± 9.93 years. The pre-operative additive EuroSCORE was 7.96 ± 2.88 (range: 2–18). Pre-operative functional capacity was impaired in 35.7% of the patients [New York Heart Association (NYHA) classes III–IV]. Mean age and preoperative EuroSCORE values of group 1 were significantly higher than those of group 2. Impaired functional capacity (NHYA classes III–IV) was also associated with mortality (OR: 3.333; 95% CI: 1.199–9.268).Fifty-four patients (64.3%) underwent on-pump CABG procedures, and 30 (35.7%) underwent off-pump CABG procedures. The study found no statistically significant difference in mortality rates between these two techniques. Mortality occurred in 12 patients (22.2%) in the on-pump group and in nine (30%) in the off-pump group. Complete revascularisation was performed on 46 patients (85.2%) in the on-pump group and seven (23.3%) in the off-pump group (p < 0.001).ConclusionAdvanced age, impaired NYHA functional capacity and pre-operative hypertension were determinative for early-term surgical mortality. An on-pump surgical technique is recommended to ensure completeness of revascularisation.

One-week treatment with iloprost may provide both long lasting symptomatic benefit and may improve hemodynamic parameters, which were shown to predict future amputation.

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