Faruk Cingoz

Carotid intima-media thickness in patients with slow coronary flow and its association with neutrophil-to-lymphocyte ratio: a preliminary report.

Background: The slow coronary flow (SCF) is characterized by angiographically normal or near-normal coronary arteries with delayed progression of the contrast agent into distal vasculature. We aimed to investigate neutrophil-to-lymphocyte (N/L) ratio and the carotid intima-media thickness (CIMT) value in patients with SCF compared to patients with newly diagnosed coronary artery disease (CAD) and normal patients. Materials and Methods: We enrolled 60 consecutive patients with SCF, 68 patients with CAD, and 72 normal patients. The association between thrombolysis in myocardial infarction frame count, CIMT, and N/L ratio and other clinical and laboratory parameters were evaluated. Results: The N/L ratio was significantly higher not only in patients with SCF but also in patients with CAD, compared to those of controls. The N/L ratio was positively and moderately correlated with CIMT in the whole study population. Conclusions: The NL ratio is significantly associated with reduced coronary blood flow, and elevated N/L ratio might be an independent predictor for the presence of SCF.

The PediPump: development status of a new pediatric ventricular assist device: update II.

The PediPump is a new ventricular assist device with a hydraulic output range designed for children from newborn infants to adolescents. The design is based on a mixed-flow rotary pump; the rotating assembly consists of a front impeller, front and rear radial magnetic bearings, and a central motor magnet. Two different implantable pumps were designed initially: an intravascular pump measuring 7 × 75 mm and an extravascular pump measuring 14 × 85 mm. Current prototypes are substantially smaller: The current intravascular version measures 4.5 × 55 mm, whereas the current extravascular version measures 11 × 70 mm. Both devices provide pressure and flows capable of supporting adults, far exceeding the initially defined physiologic requirements for children weighing 2 to 25 kg. This basic pump design may be used in acute or chronic clinical settings to provide right ventricular, left ventricular, or biventricular support. There are three objectives for the PediPump development program: 1) determination of basic engineering requirements for hardware and control logic including design analysis for system sizing, evaluation of control concepts, and bench testing of prototypes; 2) performance of preclinical anatomic fitting studies using CT-based 3D modeling; and 3) animal studies to provide characterization and reliability testing of the device.

Beating Heart Cardioscopy: A Platform for Real-Time, Intracardiac Imaging

PURPOSE The purpose of this study was to develop a method for real-time, fiberoptic, intracardiac imaging to serve as a platform for closed-chest, intracardiac surgery on the beating heart. DESCRIPTION Fiberoptic cardioscopy of the left and right heart was conducted in a porcine model. A cardiopulmonary bypass circuit maintained systemic organ perfusion and a separate circuit replaced intracardiac blood with oxygenated, modified Krebs-Henseleit perfusate. EVALUATION Video images of structures in the left and right sides of an in vivo beating heart were obtained, including the inner surface of the left and right atria and ventricles, the mitral and aortic valves, the Thebesian veins, and the coronary sinus. Effective isolation of the heart from systemic and intracardiac blood flow and control of perfusion rates were important factors for successful image acquisition. CONCLUSIONS Fiberoptic cardioscopy is a novel approach that allows for visualization of the structures within a nonarrested heart on bypass. It lays the groundwork for a platform that could lead to more successful percutaneous valvular and intracardiac procedures in a stable hemodynamic environment.

Progress in the development of the DexAide right ventricular assist device.

The DexAide right ventricular assist device (RVAD) is an implantable centrifugal pump modified from the CorAide left ventricular assist device. As previously published, in vitro performance testing of the DexAide RVAD has met design criteria, and the nominal operating condition of 4 l/min and 20 mm Hg pressure rise was achieved at 2,000 rpm, with a power consumption of 1.9 watts. In vivo studies in 14 calves have demonstrated acceptable hemodynamic characteristics. The calf inflow cannula design is still evolving to minimize depositions on the cannula observed in most experiments. Fitting studies were performed in 5 cadavers and 2 patients to reconfigure the cannulae for use in humans. The design and development of external electronics have been completed for the stand-alone RVAD system, and verification tests are under way in preparation for preclinical tests. Work on the external electronics design for the biventricular assist system is ongoing. In conclusion, the initial in vitro and in vivo studies have demonstrated acceptable hemodynamic characteristics of the DexAide RVAD. The design and development of the external electronic components for the stand-alone RVAD system have been completed. The calf inflow cannula is being redesigned, and chronic in vivo tests are under way.

The Cleveland Clinic PediPump: anatomic modeling and virtual fitting studies in a lamb model.

Implantation of ventricular assist devices (VADs) is challenging in small patients with limited space in the chest. We created three-dimensional models of lambs to facilitate fitting of the PediPump, a pediatric VAD currently under development. Serial computed tomography (CT) scans were acquired at multiple time points (n = 8) for three lambs. Digital models were created using these CT datasets and three-dimensional image processing software (Mimics, Materialise). Pixels representing the heart and chest wall were rendered as three-dimensional models. Using three-dimensional model manipulation software (Magics RP, Materialise), on-screen models of extravascular and intravascular VADs were placed in right, left and biventricular support configurations to determine optimal placement. A cannulation strategy was established and in some cases three-dimensional models of the inflow and outflow grafts were created. After the final CT study, an open-chest fitting study was performed using rapid prototype models of the pediatric VAD and cannulas. The pump location and orientation predictions from the virtual fitting studies matched those determined at the time of the open-chest fitting studies. Using three-dimensional modeling, we have established a fitting protocol that facilitates animal implantations; the same modeling techniques may be useful for device fitting in humans.

A Novel Technique for Functional Mitral Regurgitation Therapy: Mitral Annular Remodeling

BACKGROUND Functional mitral regurgitation (AIR) plays a pivotal role in the pathophysiology of congestive heart failure, a major cause of cardiac morbidity and mortality. We have developed a mitral annular remodeling procedure through injection of a nonabsorbable substance into the peri-annular tissue of the posterior mitral annulus to reduce the mitral annular dimension in the septal-lateral axis. The purpose of this study is to describe a novel procedure for treatment of functional AIR and report its effects on the geometry of the mitral annulus and degree of AIR. METHODS Seven preliminary studies were performed using an epicardial approach in a healthy dog model to establish the feasibility of this injection procedure. Unexpectedly, 2 of 7 healthy dogs had a functional AIR of grade 1 to 2+. In these 2 cases, the hemodynamic, angiographic, and echocardiographic assessments were conducted. RESULTS A nonabsorbable substance injection was successfully performed on a beating heart without instability of hemodynamics or any evidence of myocardial ischemia in all 7 dogs. In the 2 dogs with a functional AIR, it was confirmed that the septal-lateral dimension decreased from 3.2 +/- 0.2 to 2.6 +/- 0.5 cm and the observed MR was reduced (AIR area from 1.2 +/-0.1 to 0 cm2) without any adverse effects on hemodynamics or coronary circulation (circumflex artery flow, 36.5 +/- 0.4 to 40.5 +/- 0.1 mL/min). CONCLUSION Off-pump mitral annular remodeling through substance injection may be one procedural option for treatment of functional AIR.

Does combination of antegrade and retrograde cardioplegia reduce coronary artery bypass grafting-related conduction defects?

BACKGROUND Conduction disorders appearing after coronary artery bypass surgery (CABG) may have many different causes. In this study, we evaluated the postoperative conduction disorders after CABG with respect to the ante-grade blood cardioplegia and ante-grade plus continuous retrograde cardioplegia delivery methods. MATERIALS AND METHODS This retrospective study included 1824 patients undergoing CABG between January 2001 and December 2005. There were 694 female patients (38%) and 1130 male patients (62%). Myocardial protection was done by isothermic hyperkalemic blood cardioplegia. Patents in Group 1 (n = 704) were operated on using only intermittent antegrade cardioplegia and those in group 2 (n = 1120) were operated on using the antegrade plus retrograde continuous cardioplegia. The postoperative occurrences of a new right bundle branch block, left anterior hemiblock, left posterior hemiblock, left bundle branch block, or third-degree atrioventricular block were evaluated and compared. RESULTS Total mortality rate was 1.6% (29 patients) without significant difference between the groups. The preoperative and perioperative characteristics were statistically similar in the groups. The occurrence of conduction disorders was significantly higher in group 1 (P = .006, 55 versus 52 patients). The analysis of the patients with conduction disorders showed a significantly increased mortality rate (P < .001) in addition to a significantly increased period of intensive care unit follow-up and duration of postoperative hospitalization (P <.001). CONCLUSION The present study demonstrated that the perioperative occurrence of conduction disorders after CABG was decreased by antegrade controlled and retrograde continuous combination cardioplegia.

Surgical repair of aneurysm of arteriovenous fistula in patients with chronic renal failure.

The aim of the study The aim of the study was to show the efficacy and results of aneurysm reconstruction that was developed for relieving the patients from pain and mass effects and to give an early hemodialysis option. Material and methods Medical records were retrospectively screened over a period of 17 years to identify patients diagnosed with and surgically treated for aneurysm of an AV fistula. Twenty-eight patients were included in this study. The mean average age was 44 ± 3 years (31-60). Seventeen (60.7%) patients were female. Twenty-two (78.5%) patients had hypertension and 9 (32.1%) patients had diabetes mellitus. Aneurysm was examined by using ultrasonography to reveal the flow dynamics. The aneurysm was resected and an appropriate sized graft was interposed under local anesthesia. The same vein was dissected and anastomosed over the graft in an end-to-side fashion. Results Mean aneurysm diameter was 40 ± 12 mm. All aneurysm tissues and thrombotic materials were removed from the surgical field. Mean graft length was 37 ± 11 mm. Three (10.7%) patients need surgical revision because of postoperative bleeding. Dermal necrosis occurred in 1 (3.5%) patient. Infection was noted in 1 (3.5%) patient. Vascular access was started from the reconstructed venous area 2 or 4 days later in all patients. The patency rate was 100% in three years. Conclusions Surgical reconstruction of the arteriovenous fistula aneurysm can be safely performed in hemodialysis patients with low complication rates. It gives early vascular access with high patency rates. All patients are relieved from pain and distended mass effect.

Innovative, replaceable heart valve: concept, in vitro study, and acute in vivo study.

The purpose of this study was to evaluate the feasibility of our innovative, replaceable heart valves that can be easily detached from the sewing ring at the time of repeat replacement. The prototype devices consist of the base magnet ring assembly and the valve magnet ring assembly that utilize magnetic coupling force for the locking mechanism. Magnetic coupling strength was evaluated in vitro. Prototype bioprosthetic valves were implanted acutely in three sheep to confirm the feasibility of the replaceable mitral valve. The static separation force of prototype size #25 was 12.5 lb, meeting the design goal. In situ attachment and detachment of the valve magnet ring assembly from the base magnet ring assembly were very easily accomplished in all animals. The magnetic coupling did not decouple even under extremely high left ventricular pressures. We have demonstrated the feasibility of this innovative concept of a replaceable mitral valve.

Surgical challenges for urgent approach in penetrating heart injuries.

UNLABELLED The aim of this clinical study is to assess the characteristics of penetrating heart injury and its surgical challenges for urgent surgical approach. MATERIALS AND METHODS Seventeen patients suffering from penetrating heart wounds were evaluated retrospectively in the department of cardiovascular surgery between 1996 and 2004. All patients were male, with ages ranging from 19 to 36 years, with a mean age of 23.6 +/- 5 years. RESULTS Median sternotomy, left anterior thoracotomy, and right anterior thoracotomy were performed to control the bleeding or to reach the heart for internal cardiac massage in 5, 11 and, 1 control, respectively. The right ventricle was the most commonly injured chamber (64.7%, n = 12), followed by left ventricle (17.7%, n = 4), and right atrium (17.6%, n = 3); a left atrial injury was not seen. Mortality rate was 29% (5 cases), and 12 controls were discharged without any complications. CONCLUSION Although the most important factor affecting mortality in penetrating heart injuries is rapid transport, an urgent approach applied by a specialist team can decrease potential mortality and morbidity rates.