Ilker Mataraci

Five-year experience in aortic root replacement with the flanged composite graft

BACKGROUND Replacement of the aortic root with a composite graft containing a prosthetic mechanic valve is the preferred surgical procedure for tailoring the aortic root. The aim of this study is to determine the 5-year experience with the composite root replacement using our new modification of the Bentall technique. METHODS Between January 1996 and June 2001, 96 patients underwent aortic root replacement using a flanged composite graft. Eighty patients (83.3%) were male, and 16 patients (16.7%) were female with a mean age of 48.7 +/- 14.4 years. Indications for operation were a true or false aneurysm (65.6%), severe calcified aortic valve stenosis (4.2%) or severe aortic insufficiency (2.1%) with dilated ascending aorta, acute dissection (2.1%), or combination of indications (26%). Thirty-one patients (32.3%) received a concomitant cardiac procedure. Mean aortic cross-clamp time was 89.5 +/- 28.6 minutes, and mean cardiopulmonary bypass time was 146.2 +/- 45.6 minutes. Total follow-up was 253.9 patient-years. RESULTS Operative mortality was 8.3% (8 patients). The causes of hospital mortality were severe bleeding (3 patients), low cardiac output syndrome (2), acute respiratory distress syndrome (2) and cerebrovascular event (1). No patient died of flange-related complications. Univariate predictors of early mortality were low cardiac output syndrome (p < 0.001), neurologic complication (p = 0.03), and renal complication (p = 0.03). Multivariate analysis demonstrated only low cardiac output syndrome to be significant (p = 0.001) predictor for early mortality. There were five (5.7%) late deaths. Actuarial survival was 82.65% +/- 4.8% at 5 years (1.95% patient-year). Cox proportional hazards regression analysis demonstrated only low cardiac output syndrome to be significant (p = 0.032) predictor for late mortality. Actuarial freedom from prosthetic- and technique-related mortality was 100% at 5 years. CONCLUSIONS The flanged composite graft offers excellent long-term results, with very low prevalence of prosthetic-related complications. The new created sinuses and the flange are especially helpful to continue physiologic function of the aortic root.

Long-Term Results of Aortic Root Replacement: 15 Years' Experience

BACKGROUND Long-term results of aortic root replacements and the factors affecting long-term mortality were analyzed. METHODS We operated on 254 patients from June 1993 to November 2008 for aortic root replacement with Bentall de Bono procedure. Two hundred five patients were male (80.7%) and 49 patients (19.3%) were female. The mean age was 48.3 +/- 14.7 years (range, 14 to 78 years). We performed 72 concomitant procedures in 69 patients, and the most commonly performed procedure was coronary artery bypass grafting in 37 patients (14.6%). The most common indication for aortic root replacement was aneurysm in 235 patients (92.5%). Thirty-four patients (13.4%) had Marfan syndrome. Hypothermic circulatory arrest was used in 52 patients (20.5%). After removing the clamp, we had to reclamp the aorta in 26 patients (10.2%) undergoing operation. RESULTS Postoperatively 30 patients (11.8%) had in-hospital mortality. The late mortality was 2.8% (7 patients). The most common reason for hospital mortality was low cardiac output (18 in 30 patients; 51.4%). Neurologic complications were seen in 16 patients (6.3%). The mean duration of hospital stay was 16.6 +/- 11.3 days (range, 5 to 77 days). Postoperative follow-up was 6.3 +/- 4.5 years (range, 0 to 15.5 years) on average. Late mortality was significantly affected by Marfan syndrome (p = 0.025) and reclamping the aorta (p = 0.036). Actuarial survival for the overall 254 patients is 88.4% +/- 2.1%, 87.4% +/- 2.2%, and 84.5% +/- 2.56% at 1, 3, and 10 years, respectively. CONCLUSIONS The late-term results of aortic root replacement with the modified Bentall de Bono procedure are satisfactory. Survival is decreased in patients with Marfan syndrome and in the patients who had reclamping intraoperatively.

Cardiac Hydatid Cysts

Abstract  From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were diagnosed as a component of multi‐organ echinococcosis and three of them underwent operation before. They were examined serologically and echocardiographically. Cardiac hydatidosis were diagnosed in right ventricle (in three cases), left ventricle (in one case), and interventricular septum (in two cases). Sternotomy was the approach used and all patients were operated on using cardiopulmonary bypass. Intraoperative rupture did not occur. There was no operative mortality, the only morbidity was complete atrioventricular block necessitating VVD pacemaker implantation in the patient with hydatid cyst involving the basal interventricular septum. All patients were followed by medical treatment with albendazole (400 mg/day) and no recurrences were reported in the late follow‐up.

Postoperative Revision Surgery for Bleeding in a Tertiary Heart Center

We analyzed cases of re-exploration for bleeding after 19,680 open heart operations performed between January 1995 and January 2009 to determine the risk factors for mortality and morbidity. Half of the 282 patients reexplored had nonsurgical causes of bleeding. The patients were grouped according to the timing of reoperation, early reexploration being on the day of the operation. Mortality, total morbidity, and the need for transfusion of any blood product were compared between the early and late reexploration groups. Most patients (77.7%) were reexplored early. Overall mortality was 8.5% (24 patients). Mortality, total morbidity, renal, gastrointestinal, neurologic and infectious complications, and low cardiac output differed significantly between the 2 groups. Significant predictors of mortality were old age, female sex, left ventricular dysfunction, noncoronary operations, and delayed reoperation. Predictors of morbidity were old age, preoperative dialysis, tobacco use, chronic lung disease, and delayed reoperation. No factors were found to be associated with the need for transfusion.

Does Mediastinitis Affect the Graft Patency

Abstract  As inflammation began to be recognized as a major contributor to the pathogenesis of atherosclerosis, we evaluated the patients that developed mediastinitis, a long‐standing inflammatory process, after coronary artery bypass grafting. There are many studies that have focused on the graft patency. But, till now, no study has been done to detect the effects of mediastinitis to graft patency. So, we aimed to detect the effect of mediastinitis on the graft patency in patients who have undergone coronary artery bypass surgery. Sixteen of 45 patients who have been operated upon for coronary artery bypass surgery and developed mediastinitis, which was treated with open drainage and mediastinal irrigation with late wound closure, were included in the study. The mean age of the patients was 55 ± 11 (range 35–69) and nine of the patients were male. The graft patency was evaluated with control coronary angiographies after a mean period of 30.42 ± 43.17 months (range 1–132). The left internal thoracic artery was patent in all patients (100%). Right internal thoracic artery patency rate was 50% (1/2). One individual bypassed radial artery was patent, whereas the sequential bypassed graft was occluded. The patency ratio of radial artery anastomosis was 33% (1/3). Twelve of the 17 saphenous vein grafts were patent (70.58%). The total number of patent distal anastomosis was 30/38 (78.94%). When compared with the graft patency of patients without infection, it was found that mediastinitis does not affect the graft patency rates adversely.

Radiofrequency Ablation for Atrial Fibrillation in Rheumatic Valvular Disease

BACKGROUND We have reviewed the results of radiofrequency ablation (RFA) in patients with rheumatic valve disease. METHODS Sixty-seven patients underwent operation for rheumatic valvular disease and RFA concomitantly with the planned procedure. Twenty-two (32.8%) were male and 45 (67.2%) female. The mean duration of atrial fibrillation (AF) was 47.4+/-30.4 months (12-192). Logistic regression test was used to perform a risk factor analysis. RESULTS Two patients died postoperatively (3.0%) and 3 died in the follow-up period (4.5%). One patient (1.5%) required permanent pacemaker. During the hospitalisation, 24 patients (35.8%) had AF but 6 of them returned to the normal sinus rhythm by the time of discharge. Forty-nine patients (73.1%) were discharged with normal sinus rhythm. The mean duration of follow-up was 15.1+/-15.2 months (0-59). Six patients (9.0%) had recurrent AF during the follow-up period. For early AF recurrence male sex was a significant risk factor (p=0.028) with an odds ratio 8627 (CI 95% 1261-59,006). CONCLUSIONS The low sinus rhythm rate at discharge and high rates of recurrence may be attributed to the disease nature. Males are at increased risk of early AF recurrence but no significant risk factors for late recurrence have been found.