In elderly, high-risk surgical patients, sutureless aortic valve replacement (AVR) can often be an alternative to conventional AVR; shorter aortic cross-clamp and cardiopulmonary bypass times are the chief advantages. We compared the outcomes of sutureless AVR with those of conventional AVR in 70 elderly patients who underwent concomitant cardiac surgical procedures. We retrospectively analyzed the cases of 42 men and 28 women (mean age, 70.4 ± 10.3 yr; range, 34-93 yr) who underwent cardiac operations plus AVR with either a sutureless valve (group 1, n=38) or a conventional bioprosthetic or mechanical valve (group 2, n=32). Baseline patient characteristics were similar except for worse New York Heart Association functional status and the prevalence of diabetes mellitus in group 1. In group 1, the operative, cross-clamp, and cardiopulmonary bypass times were shorter (all =0.001), postoperative drainage amounts were lower (=0.009), hospital stays were shorter (=0.004), and less red blood cell transfusion was needed (=0.037). Echocardiograms before patients' discharge from the hospital showed lower peak and mean aortic gradients in group 1 (mean transvalvular gradient, 8.4 ± 2.8 vs 12.2 ± 5.2 mmHg; =0.012). We found that elderly, high-risk patients who underwent multiple cardiac surgical procedures and sutureless AVR had better hemodynamic outcomes and shorter ischemic times than did patients who underwent conventional AVR.

In patients with respiratory failure and impairment of the left ventricle, arteriovenous extracorporeal membrane oxygenation (ECMO) offers further therapeutic options. Systemic anticoagulation is mandatory and heparin is routinely administrated. However, repeated exposure to heparin may cause heparin-induced thrombocytopenia (HIT) and carries a risk of thrombotic mortality and morbidity. We present a patient who developed HIT during ECMO support and was treated successfully and safely by fondaparinux. Fondaparinux can be used for thromboembolic treatment or prophylaxis in a patient with HIT.

Compartment syndrome is commonly seen following lower extremity ischemia. However, upper extremities' compartment syndrome, especially after any vascular surgical procedures, is infrequent. Herein we report a case of an acute forearm compartment syndrome that was developed after delayed brachial artery embolectomy.

BackgroundIn elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation.MethodsBetween October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used.ResultsThe mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%.ConclusionIn the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

With the development of technology and surgical experiences, minimally invasive approaches are getting more preferable by physicians. Also these smaller incisions provide patients to have higher life quality at their postoperative periods. In this study we aimed to report our minimally invasive approach experiences. Patients and Methods: In our clinic 10 patients underwent open heart surgery with minimally invasive approaches between March 2010 and January 2014. The mean age was 50.5±26 years (range, 22-82 years). Six of them were females (60%). Four patients have had previous open heart surgery through standard sternotomy. Ministernotomy was performed in 4 patients, 5 patients' operations were done via right anterior mini-thoracotomy and one patient was operated via left anterior minithoracotomy. Results: The mean operation duration was 6.8±1.8 hours (range, 4-10 hours) (time elapsed from anesthesia induction to wound closure with sterile sponge). Only one patient was extubated in operating theatre. Early mortality (in postoperative 30 days) was seen in only one patient. One patient was admitted to hospital with wound complication and re-hospitalized for wound care. Conclusion: With developments in cardiac surgery field, many disorders are repaired via minimally invasive techniques providing exposures as good as conventional approaches. In recent years, many clinics reported their experiences at these applications with excellent results. Minimally invasive cardiac surgery does not have worse mortality rates than standard techniques. Also, it enables patients to return to their own normal activities, providing them with less wound complications. With the increasing experiences, minimally invasive cardiac surgery may be considered in those appropriate patients and particularly in patients who care about their own appearances.

The effects of double (n = 60, group 1) versus single (n = 60, group 2) aortic clamping on myocardial function and protection were investigated during coronary artery bypass grafting using a heart-lung pump. In group 1, after opening the cross clamp, proximal anastomosis was completed using side clamps and, in group 2, distal and proximal anastomosis was completed with a single clamp. Cross clamping time in the single-clamp patients (group 2; 77.1 min) was significantly higher than in the double-clamp patients (group 1; 62.9 min). Troponin T was significantly higher in group 2 than in group 1 h and 24 h after surgery. Post-operative left ventricular ejection fraction decreased in both groups, but this was not statistically significant. Post-operative wall motion score index and myocardial performance index increased significantly in both groups compared with the pre-operative level. Overall, the double-clamp technique provided better myocardial protection than the single-clamp technique and neither technique seemed to have a negative impact on the early post-operative global functioning of the left ventricle, however the effect of these techniques on the global functioning of the left ventricle in the late postoperative period needs to be evaluated.

Objective To compare immediate postoperative results in patients receiving heparin-albumin-coated and non-coated circuits. Methods A total of 241 patients undergoing on-pump cardiac surgery were divided into two groups: those receiving heparin-coated circuits (Bioline®, Maquet Cardiopulmonary AG., Hirrlingen, Germany) and those receiving non-coated circuits (Maquet Cardiopulmonary AG., Hirrlingen, Germany). Results Activated clotting times (ACT) during cardiopulmonary bypass (CPB) were significantly shorter in the heparin-albumin-coated group than in the non-coated group (355.64±34.12 vs. 560.38±90.20, respectively, P =0.001). In-hospital mortality and postoperative stroke rates and lengths of intensive care unit stay were similar between the groups; in contrast, in the heparin-albumin-coated group, patients had significantly better outcomes for hospital stay, drainage, and need for erythrocyte transfusion. Conclusion Heparin-coated circuits and reduced level of systemic heparinization with 300 seconds of target ACT level in cardiac surgery under CPB are safe and result in a very satisfactory clinical course.

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