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BackgroundAlthough off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.MethodsBetween January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.ResultsOPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.ConclusionsThe patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.

Findings suggest a link between enhanced netrin-1 expression in EAT and macrophage infiltration and polarization in patients with CAD.

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How to cite/Atıf için: Şahinalp Ş, Çeviker K, Soyal MFT, Gür AK. Retrospective evaluation of ultrafiltration during cardiac surgery with cardiopulmonary bypass in adult patients with increased neutrophil to lymphocyte ratio.

Background. The value of polytetrafluoroethylene (PTFE) surgical membrane as a pericardium substitute in patients who undergo reoperation for rheumatic valve disease is reported in this observational study. Methods. PTFE was used for pericardial closure in 56 rheumatic valve patients. During reoperation of seven cases, adhesions were classified as none, minimal, moderate to severe and scored in the sections of heart. Data found at reoperations were collected prospectively in all patients. Results. Seven of 56 patients reoperated mean period of 67.1 ±23.4 (SD) months later. No infection, complication and operative or late death attributable to the membrane were observed. There were two right ventricular, three minimal right atrial and one innominate vein lacerations during resternotomy and all of them were controlled. During histological examination, a microscopically significant foreign body reaction was found. Conclusion. PTFE membrane produced an undesirable fibrous membrane that obscured the epicardial anatomy and hardened the dissection in patients with rheumatic heart disease.

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