Cardiovascular Surgery and Interventions
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Comparison of the metabolic effects of eplerenone and spironolactone via plasma galectin-3 level in patients with heart failure
Hakan Göçer, Ahmet Barış Durukan, Mustafa Ünal
Objectives: This study aims to compare the metabolic effect of eplerenone and spironolactone, mineralocorticoid receptor blockers, in patients with heart failure via galectin-3 plasma level. Patients and methods: Between March 2018 and July 2018, 20 heart failure patients (12 males, 8 females; mean age 65.2±7.6 years; range, 58 to 73 years) diagnosed based on clinical parameters and echocardiographic findings were randomized (1:1) to either spironolactone (25 mg/day) or eplerenone (50 mg/day). All patients were also given standard heart failure treatment. We measured plasma levels of galectin-3 with biochemically. Galectin-3 levels were compared before the study and four months after both spironolactone and eplerenone treatment. Results: The mean ejection fraction of the patients was 25.0±4.6% in the eplerenone group and 25.0±4.7% in the spironolactone group. Demographic and hemodynamic characteristics of the patients were comparable between the groups. In both groups, plasma galectin-3 levels were not significantly different prior to initiation of mineralocorticoid receptor antagonist therapy (p=0.307). In patients receiving eplerenone, the mean plasma galectin-3 levels decreased from 898.6±23.4 to 99.7±7.9 four months after the treatment (p=0.0004). In the spironolactone group, galectin-3 levels prior to and after treatment did not change significantly (p=0.201). Conclusion: Galectin-3 concentration, which is an emerging marker of cardiac fibrosis, statistically decreased in the eplerenone group rather than spironolactone group. Based on this finding, we can speculate that eplerenone is more effective than spironolactone in preventing fibrosis and inflammation in patients with heart failure.
Effects of systemic inflammatory response on coronary artery bypass grafting
Nihan Yeşilkaya1, Orhan Gökalp1, Hasan İner1, Yüksel Beşir1, Hüseyin Durmaz2, Yaşar Gökkurt2, İhsan Peker2, Levent Yılık1, Ali Gürbüz1
1Department of Cardiovascular Surgery, Izmir Katip Çelebi University Faculty of Medicine, Izmir, Turkey
2Department of Cardiovascular Surgery, Izmir Katip Çelebi University Atatürk Research and Training Hospital, Izmir, Turkey
Objectives: In this study, we aimed to investigate the effects of systemic inflammatory response syndrome (SIRS) on postoperative results of coronary artery bypass grafting (CABG). Patients and methods: Between April 2016 and April 2018, a total of 287 patients (203 males, 84 females; mean age 62.5 years; range, 21 to 89 years) who underwent CABG were retrospectively analyzed. Data were collected from the medical records. The diagnosis of SIRS was made according to the criteria used by Boehme. Results: In total, 83.9% of the patients had postoperative SIRS. Univariate analysis revealed that the predictive factors of SIRS were age, preoperative EuroSCORE, on-pump surgery, and preoperative low hemoglobin levels. However, age was detected as the only predictive factor in the multivariate analysis. The diagnosis of SIRS did not affect hospital mortality, neurological complications or length of hospital stay, whereas it prolonged the weaning period and length of intensive care unit stay. Conclusion: Our study results show that SIRS has no significant effect on mortality and neurological complications in CABG patients. On the other hand, special attention should be given to the inflammatory response, as it prolongs the weaning period and length of intensive care unit stay
In which conditions should we insert an intra-aortic balloon pump? In the operating room or intensive care unit?
Hasan İner, Nihan Yeşilkaya, Orhan Gökalp, Yüksel Beşir, Levent Yılık, Ali Gürbüz
Department of Cardiovascular Surgery, Katip Çelebi University Faculty of Medicine, Izmir, Turkey
Objectives:In this study, we aimed to evaluate complications of intra-aortic balloon pump catheters inserted percutaneously in the operating room versus in the intensive care unit setting. Patients and methods: Between January 2013 and January 2016, a total of 71 patients (54 males, 17 females; mean age 63.0 years, range, 41 to 84 years) who underwent percutaneous intra-aortic balloon pump insertion in the operating room or in the intensive care unit were retrospectively reviewed. The patients were divided into two groups as Group 1 (n=48) consisting of the patients with intra-aortic balloon pump inserted in the operating room and Group 2 (n=23) consisting of those who underwent intra-aortic balloon pump in the intensive care unit. Both groups were compared in terms of pre- and post-procedural data and the effects of intra-aortic balloon pump insertion performed in the intensive care unit and operating room settings on reproductive pathology results of the catheters were assessed. Results: The mean pre- and post-procedural platelet counts were significantly higher in Group 2 than Group 1. After the procedure, the incidence of growth only was higher in the cultures collected from the tips of the catheters inserted in the intensive care unit. Conclusion: Insertion of intra-aortic balloon pump catheters in the operating room is more secure than the catheters inserted in the intensive care unit in terms of catheter infections. Therefore, in patients who are scheduled for intra-aortic balloon pump support in the intensive care unit setting, this procedure should be considered to be performed under operating room conditions, if the mobility of the patient is ensured.
Comparison of early treatment outcomes after aortic valve replacement with sutureless, bioprosthetic, and mechanical valves: Our single-center experience with 140 patients
Gökhan İlhan1, Şahin Bozok2, Mustafa Çağdaş Çayır3, Nebiye Tüfekçi4, Şeref Alp Küçüker5
1Department of Cardiovascular Surgery, Muğla Sıtkı Koçman University, Training and Research Hospital, Muğla, Turkey
2Department of Cardiovascular Surgery, Uşak University Faculty of Medicine, Uşak, Turkey
3Department of Cardiovascular Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey
4Department of Cardiovascular Surgery, Yıldırım Beyazıt University, Yenimahalle Training and Research Hospital, Ankara, Turkey
5Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
Objectives: The aim of the present study was to comparatively assess the perioperative findings and early therapeutic outcomes in patients who underwent aortic valve replacement (AVR) with sutureless, bioprosthetic, and mechanical valves. Patients and methods: This prospective cohort included a total of 140 patients (78 males, 62 females; mean age 68.5 years range, 36 to 82 years) who underwent AVR in the cardiovascular surgery department of a tertiary care center between January 2013 and September 2016. The patients were divided into three groups according to the valve implanted: sutureless (Group 1, n=48), bioprosthetic (Group 2, n=44), and mechanical (Group 3, n=48) valve groups. Baseline demographic and clinical characteristics, comorbidities, pre- and postoperative echocardiographic findings, hemodynamic parameters, additional interventions, complications, and early therapeutic outcomes were recorded in three patient groups. Results: Ejection fraction was significantly lower (p=0.026) and the New York Heart Association functional class was significantly higher (p=0.002) in the sutureless valve group. Duration of operation, cross-clamp time, and duration of cardiopulmonary bypass were significantly shorter in the sutureless valve group (p<0.001 for all). Duration of intubation, the amount of erythrocyte suspension transfusion and drainage, and the length of hospitalization and intensive care unit stay were shorter in the sutureless valve group (p<0.001). Comparison of pre- and postoperative echocardiographic findings within each group revealed that maximum and mean aortic gradients were improved in three groups after the operation. However, there was no statistically significant difference in ejection fraction and pulmonary arterial pressure postoperatively among the groups. Conclusion: Based on our study findings, we conclude that selection of the valves before AVR procedure must be made according to the characteristics of the patient including comorbidities and hemodynamic profile.
Off-pump coronary artery surgery with clamshell incision
Mehmet Ali Şahin, Erkan Kuralay
The clamshell incision is a type of incision which provides excellent exposure to the thoracic and cardiac structures. Herein, we report a case of laryngeal cancer with previous tracheostomy who underwent off-pump coronary artery bypass surgery using the saphenous vein graft via the clamshell incision The postoperative course was uneventful and the patient was discharged on postoperative Day 10 with recovery.
Outcomes of the Istanbul Symposium on minimally invasive and robotic cardiac surgery
Department of Cardiovascular Surgery, University of Health Sciences Turkey, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
The Turkish Society of Cardiovascular Surgery (TSCVS) has been actively engaged in organizing congresses, school programs for education, local meetings, and symposiums on thoracic and cardiovascular surgery since 1988. The main goals of all these programs are to educate new generations, to share growing experience with other colleagues, and to promote the best health care to patients with cardiovascular disease. The most final of these symposiums took place at Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital (IMAEH) on the date of December 20th, 2019. The symposium hosted different aspects and experiences on minimally invasive and robotic cardiac surgery in adult patients. The conference lasted for one day and cardiac surgeons, adult cardiologists, nurses, technicians, and perfusionists attended the meeting. Twelve researchers from different hospitals shared their experiences. After scientific sessions, a wet-lab panel was held on robotic cardiac surgery, including simulation training on the daVinci robotic surgical system.
ACE-gene polymorphism, particularly "D/I", may play a role in the occurrence of COVID-19 pneumonia in hypertensive elderly patients
Hakan Göçer1, Ahmet Barış Durukan21Department of Cardiology, Medical Park Uşak Hospital, Uşak, Turkey
2Department of Cardiovascular Surgery, Medical Park Uşak Hospital, Uşak, Turkey
Renin-angiotensin-aldosterone system has an important role in the pathophysiology of high blood pressure. Also, angiotensin II and bradykinin are vasoactive molecules with multiple acute and chronic effects on the cardiovascular system.[1,2] As stated in recent reports, COVID-19 pneumonia more frequently occurs in COVID-19-positive hypertensive elderly. To the best our knowledge, COVID-19 pneumonia has a grave prognosis in hypertensive and elderly patients. Angiotensin-converting enzyme (ACE) genotype has been blamed for this course, and although the interaction between COVID-19 and ACE receptors interaction has been well defined, ACE genotype polymorphism has not been fully elucidated, yet. In this infection, many researches and reports have shown the effect of ACE insertion deletion (I/D) gene polymorphism on risk, prognosis, and reaction to treatment of many diseases such as hypertension, heart failure, myocardial infarction, diabetes, diabetic nephropathy, and cancer. It is well-known that ACE gene is located on chromosome 17 and polymorphism consists of three types within the intron 16 (DD, ID, II) and depends on heredity, ethnicity, and geographical considerations. Furthermore, D/I type has been found more frequently in hypertension, diabetes, and myocardial infarction. Prognosis is more grave in this genotype polymorphism. Our suggestion is that D/I type ACE gene polymorphism should be a research of interest for predicting prognosis and propensity of COVID-19 infection in hypertensive elderly patients.
Normalization process of cardiac operations in COVID-19 pandemic
Department of Cardiovascular Surgery, Izmir Katip Çelebi University, Faculty of Medicine, Izmir, Turkey
The severe acute respiratory syndromecoronavirus- 2 (SARS-CoV-2; COVID-19), which was first identified in Wuhan province of China in the late December 2019, has infected approximately 3,700,000 individuals worldwide and more than 250,000 deaths have been reported until the first quarter of May 2020. The level of danger for the modern world’s healthcare system is revealed, when the possibility of undiagnosed cases, multiple times more than reported numbers, is considered. As a result of this catastrophic scenario, healthcare systems have been reorganized all over the world. The most widely adopted practice is to prioritize COVID-19 patients in all healthcare units and to postpone all diagnose and treatment procedures to a reasonable future date, unless it is urgent or indispensable. The effect of delay in diagnosis and treatment on patients other that those with COVID-19 is a totally different subject of debate on this kind of practice. Nevertheless, we can briefly state that the whole world has to face with this effect of the temporary, but the de novo healthcare system.