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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.

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Introduction:Pulmonary arterial hypertension (PAH) is an important risk factor for increased mortality and morbidity during mitral valve surgery. In this study, we analysed the haemodynamic effects of the prostaglandin analogue iloprost in patients with PAH. Patients and Methods:We retrospectively analysed patients with PAH who were undergoing mitral valve surgery and had received intravenous iloprost therapy at our hospital from 1 January 2003 to 31 March 2013. Systemic and pulmonary arterial pressures were measured with catheterisation. The haemodynamic parameters were administered preoperatively and at 0 hours and 24 hours postoperatively.Results: A total of 135 patients had undergone mitral valve operations, of whom 78 patients were administered iloprost during the study period. Of all the cases, 29.9% were male and the average patient age was 54.45 ± 12.48 years. A comparison of the preoperative, hour 0 and hour 24 baseline parameters showed that pulmonary artery pressure and blood pressure statistically significantly decreased at postoperative hour 24 (p< 0.05). Age, preoperative EF and revisions were found to be statistically significant risk factors for mortality (p< 0.0001). Pulmonary pressures did not affect mortality and were not classified as risk factors. Conclusion: Iloprost treatment might improve postoperative outcomes in patients with high pulmonary arterial pressures and with decreasing pulmonary arterial pressures in the early postoperative period. Treatment with iloprost during the mitral valve replacement decreases high pulmonary arterial pressures and the peroperative mortality risk. ÖZET Giriş: Mitral kapak cerrahisinde artmış pulmoner arter basıncı artmış mortalite ve morbidite için önemli bir risk faktörüdür. Biz bu çalışmada, prostaglandin analoğu iloprostun, pulmoner arteryel hipertansiyonu (PAH) olan hastalardaki hemodinamik etkilerini araştırdık. Hastalar ve Yöntem: Çalışmamızda hastanemizde 01.01.2003-31.03.2013 tarihleri arasında mitral kapak cerrahisi uygulanan ve PAH nedeniyle intravenöz iloprost tedavisi uygulanan hastalar retrospektif olarak incelendi. Hastaların sistemik ve pulmoner arter basınçları kateter aracılığıyla elde edildi. Elde edilen preoperatif, postoperatif 0. ve 24. saatteki hemodinamik değerler incelendi.Bulgular: Bu periyotta 135 hastaya mitral kapak replasmanı uygulanmış olup, 78 hastaya PAH nedeniyle iloprost tedavisi verilmişti. Hastaların %29.9'u erkek olup hastalar ortalama 54.45 ± 12.48 yaşında idi. Preoperatif değerler ile postoperatif 0 ve 24. saat sistemik ve pulmoner basınçlar karşılaştırıldığında; postoperatif 24. saatte pulmoner arter basıncının ve kan basıncının istatistiksel olarak anlamlı derecede azaldığı görüldü (p< 0.0001). Yaş, preoperatif ejeksiyon fraksiyonu ve revizyon mortalite açısından anlamlı risk faktörü olarak belirlendi (p< 0.0001). Pulmoner basınçlar mortalite açısından risk faktörü olarak bulunmadı. Sonuç:Yüksek pulmoner arter basınçlı hastalarda iloprost tedavisi postoperatif erken dönemde pulmoner arter basıncını düşürerek hastan...

Introduction In this study, we aimed to present three different methods for symptomatic aberrant right subclavian artery (ARSA) surgery. Methods We identified 11 consecutive adult patients undergoing symptomatic and/or aneurysmal ARSA repair between January 2016 and December 2020. Symptoms were dysphagia (n=8) and dyspnea + dysphagia (n=3). Six patients had aneurysm formation of the ARSA (mean diameter of 4.2 cm [range 2.8 - 6.3]). All data were analyzed retrospectively. Results Median age of the patients (7 females/4 males) was 55 years (range 49 - 62). The first four patients (36.4%) underwent hybrid repair using thoracic endovascular aortic repair (TEVAR) and bilateral carotid-subclavian artery bypass (CScBp). Three patients (27.2%) were treated by open ARSA resection/ligation with left mini posterolateral thoracotomy (LMPLT) and right CScBp. And the last four patients (36.4%) underwent ARSA resection/ligation with LMPLT and ascending aorta-right subclavian artery bypass with upper mini sternotomy (UMS). Two of the four patients who underwent TEVAR + bilateral CScBp had continuing dysphagia cause of persistent esophageal compression. Brachial plexus injury developed in one of three patients who underwent LMPLT + right CScBp. Pleural effusion treated with thoracentesis alone was observed in one of four patients who underwent UMS + LMPLT. Conclusion Among the symptomatic and/or aneurysmal ARSA treatment approaches, surgical and hybrid methods are used. There is still no consensus on how to manage these patients. In our study, we recommend the UMS + LMPLT method, since the risk of complications with anatomical bypass is less, and we have more successful surgical results.