Irfan Tasoglu

Preoperative Neutrophil–Lymphocyte Ratio and Saphenous Vein Graft Patency After Coronary Artery Bypass Grafting

Aim: The aim of the present study was to investigate the predictive value of preoperative neutrophil–lymphocyte ratio (NLR) in postoperative saphenous vein graft patency in patients undergoing coronary artery bypass grafting (CABG) surgery. Method: We retrospectively analyzed 444 patients who had undergone CABG and a further control coronary angiography due to recurrence of symptoms. The patients were divided into tertile groups according to the NLR. The primary end point was 50% saphenous vein graft stenosis or more or complete occlusion. Result: The saphenous vein graft failure in the 3 groups based on NLR was 33%, 66.2%, and 79.1%, in the low-, middle- and high-risk groups, respectively. In multivariate regression modeling, current smoker, diabetes mellitus, target artery diameter <1.5 mm, and NLR independently predicted saphenous vein graft patency in patients after CABG. Conclusion: Preoperative NLR is clearly an independent predictor of saphenous vein graft patency in patients after CABG.

Usefulness of Neutrophil/Lymphocyte Ratio as a Predictor of Amputation after Embolectomy for Acute Limb Ischemia

BACKGROUNDnThe aim of this study was to examine the predictive ability of admission neutrophil/lymphocyte ratio (NLR) for predicting amputation in patients with acute limb ischemia who underwent embolectomy.nnnMETHODSnWe retrospectively analyzed the clinical, hematologic, and amputation data of 254 patients who had undergone embolectomy for acute limb ischemia. There were 152 (52%) men and 93 (48%) women, with a mean age of 66.04 ± 13.30 years. The admission NLR was determined by dividing the absolute neutrophil count by the absolute lymphocyte count. The primary end point was determined as amputation and death.nnnRESULTSnThe mean duration of follow-up was 26 months. During the follow-up period, there were 18 (7%) amputations within 30 days of surgery and 36 (15%) amputations over a mean follow-up of 26 months. Based on multivariate logistic regression modeling, no arterial back bleeding and preoperative NLR were observed to be independent risk factors for amputation within 30 days of surgery, and no arterial back bleeding and preoperative NLR were observed to be independent risk factors for midterm amputation for the same time period. A NLR of ≥5.2 was taken as the cutoff based upon the receiver operating characteristic. In receiver operating characteristic curve analysis, a NLR ≥5.2 had 83% sensitivity and 63% specificity in predicting amputation within 30 days of surgery and 63% sensitivity and 63% specificity in predicting midterm amputation.nnnCONCLUSIONSnAn elevated NLR is associated with a poorer limb survival after embolectomy. This simple, inexpensive test may therefore be added to risk stratification of these high-risk patients.

Preoperative beta-blocker use reduces atrial fibrillation in off-pump coronary bypass surgery.

Background:u2003 Atrial fibrillation (AF) after coronary artery bypass graft surgery constitutes the most common sustained arrhythmia and results in many complications. The purpose of this study was to assess the effects of prophylactic use of beta‐blockers against atrial fibrillation in off‐pump surgery patients in the early postoperative period.

Does really previous stenting affect graft patency following CABG? A 5-year follow-up

The aim of this study was to compare the graft patency rates among patients who had a previous history of percutaneous coronary intervention (PCI) followed by coronary artery bypass grafting surgery (CABG) with the patients who had experienced CABG surgery alone. The 69 patients who were included in the study had a history of bare metal stent implantation prior to CABG (group 1). The coronary angiography results were compared with 69 patients who had a previous history of CABG (group 2). Graft patency rates of the left anterior descending artery and circumflex anastomoses are statistically significant for both groups, whereas the right coronary artery anastomoses are not statistically significant (pxa0=xa00.008; 0.009; 0.2). Graft patency rate of LIMA–LAD anastomoses was 43.9xa0±xa010.8xa0% in group 1 and 86.2xa0±xa06xa0% in group 2 for means of 60xa0months (pxa0=xa00.0001) and circumflex coronary artery anastomosis is 28.9xa0±xa00.9xa0% in group 1, 65.7xa0±xa010.8xa0% in group 2 (pxa0=xa00.0001) and the right coronary artery anastomosis is 37.2xa0±xa013.6xa0% in group 1, 56.4xa0±xa08.9xa0% in group 2 (pxa0=xa00.0001). The graft patency rates of coronary arteries without previous stent implantation were higher than the patients with previous stent implantation and experienced CABG. The results suggest that prior PCI may induce atherosclerotic events in the vessel that can adversely affect graft patency after surgery.

Ventricular fibrillation following removal of temporary epicardial pacemaking wires

Temporary wires are routinely sutured to both the atrial and ventricular epimyocardium after open heart surgery. Despite their rarity, complications related to removal of such pacemaking wires may cause life threatening situations. We describe here a patient who developed ventricular fibrillation immediately after removal of temporary epicardial pacemaking wires.

The management of complicated sternal dehiscence following open heart surgery.

BACKGROUNDnWound infection after median sternotomy for cardiac or thoracic surgery is a serious complication, and there is a lack of agreement regarding the best treatment method. We present our results in patients with mediastinitis treated with longitudinally affixed titanium plates on sternal halves.nnnMETHODSnThe technique was composite closure using titanium fixation plates to buttress the sternum in combination with circumferential stainless steel wires. The series included 21 patients who developed sternal non-union resulting from mediastinitis. Mobilization of muscular flaps was performed in 8 cases. This technique also consists of sternal and soft tissue debridement and wound closure over mediastinal tubes with continuous irrigation and drainage. Antibiotherapy based on culture and sensitivity data continued for 4 to 7 weeks.nnnRESULTSnTwenty patients achieved complete wound healing without further operative intervention or major complication. Nineteen patients treated with this technique survived. One patient died from sepsis after developing residual focus of chondritis and undergoing wide resection of cartilage, and 1 patient died from complications of severe stroke.nnnCONCLUSIONnWe had good success using aggressive early debridement, closure of the sternal halves with titanium plates, mobilization of muscular flaps, high-volume mediastinal irrigation, and intravenous antibiotics. This approach was a successful salvage technique for revision cases in achieving sternal stability and union when standard methods of closure failed or were unlikely to succeed.

10 cm H2O PEEP application in laparoscopic surgery and cerebral oxygenation: a comparative study with INVOS and FORESIGHT

AbstractIntroductionnIn the present study, changes in hemodynamic parameters and cerebral oxygen saturation (rSO2) associated with 10xa0cmxa0H2O PEEP application were investigated, which is assumed beneficial for the respiratory functions and oxygenation during laparoscopic cholecystectomy (LC) applied at 30° head-up left side position. Data gathered via two devices, namely INVOS and FORESIGHT, were compared.nMethodsAfter both the ethics committee approval from the hospital and patients’ written consents were obtained, patients undergoing elective laparoscopic surgery (only ASA I–II) were randomly divided into two groups (Clinical trials protocol NCT02071550). Sensors of INVOS and FORESIGHT devices were placed on the right side at the forehead region. In total, 11 evaluation periods were formed, namely pre-induction (1st period), post-induction (2nd period), abdominal insufflation outset (3rd period), post-insufflation at 5-min intervals (4th, 5th, 6th, 7th, and 8th period), at the end of insufflation (9th period), at the end of operation (10th period), and at the end of anesthesia (11th period). While one of the groups did not receive PEEP (ZEEP group), the other group received 10xa0cmxa0H2O along with abdominal insufflation (PEEP group). Demographic data, hemodynamic values, and rSO2 values were recorded for both groups at all 11 periods.ResultsA total of 44 patients in two groups, each group containing 22 individuals, were included in the study. Systolic, diastolic, and mean arterial pressures, etCO2 and SO2 values, and demographic data were found to be similar in both groups. Heart rate was observed to be higher in the PEEP group starting with the PEEP administration. INVOS rSO2 values were found similar in both groups. However, FORESIGHT rSO2 values were found to be higher in the PEEP group compared to the ZEEP group. No patient had cerebral desaturation in both groups throughout the study.DiscussionApplication of PEEP with 10xa0cmxa0H2O during abdominal insufflation could increase the rSO2 value and heart rate in patients undergoing laparoscopic cholecystectomy. However, all changes observed were within normal limits. FORESIGHT device yielded more compatible results with hemodynamic data compared to INVOS.

Groin Swelling in a Four-Year-Old Boy: Primary Great Saphenous Vein Aneurysm.

Primary venous aneurysm, especially in pediatric population, is a very rare clinical entity. We report a case of primary great saphenous vein aneurysm in a 4-year-old boy. He was initially suspected of suffering from inguinal hernia because the soft mass was detected at the inguinal region when the patient was in the standing position, but color Doppler ultrasonography demonstrated the swelling to be a great saphenous vein aneurysm. We decided that surgery was the best option because of potential risk for thromboembolism.

The problematic of polytetrafluoroethylene membranes for valvular repair

The problematic of polytetrafluoroethylene membranes for valvular repair _ Irfan Taşo glu, Tu gba Avcı*, Ardit Collaku and Mustafa Paç Department of Cardiovascular Surgery, Yüksek _Ihtisas E gitim ve Araştırma Hastanesi, Ankara, Turkey * Corresponding author. Department of Cardiovascular Surgery, Yüksek _Ihtisas E gitim ve Araştırma, Hastanesi, Ankara 06100, Turkey. Tel: +90-505-4402428; fax: +90-312-2290148; e-mail: dr.tugbadonmez@gmail.com (_I. Taşo glu). Received 29 August 2016; received in revised form 7 October 2016; accepted 19 October 2016

The Platelet-Lymphocyte Ratio Predict the Risk of Amputation in Critical Limb Ischemia

Background: The aim of this study was to PLR (paltelet-lymphcyte ratio) might represent significant prognostic indices in patients with CLI (critical limb ischemia) and might provide superior prognostic information. nMaterials and methods: One hundred and fourty one patients presented with CLI to our hospital between February 2007 and June 2012 who could not have radiological or surgical revascularization and had medical treatment are included in our study (n:133). Primary end point was determined as amputation (limb survival) and all-cause death and separate analyses were performed. nResults: Out of the 133 patients in the study. There were a total of 28 (26.9%) deaths and 46 (34%) amputation over a mean follow-up of 46 months. The amputations were above ankle in 24 (77%), below ankle in 7 (23%). All patients were grouped in two, those undergone amputation and those without amputation. Diabetes mellitus, hemoglobin and platelet levels, mean PLR, PLR ≥ 160 were strong univariable predictor of amputation. nConclusion: Significant prognostic information can be obtained from routine blood results in patients with CLI. Stratification of CLI patients according to admission PLR should be considered in the limb survival analyses of future adjuvant and neoadjuvant trials to validate these findings.