Koray Aykut

Figure-of-Eight Versus Prophylactic Sternal Weave Closure of Median Sternotomy in Diabetic Obese Patients Undergoing Coronary Artery Bypass Grafting

BACKGROUND Sternal dehiscence is a serious and potentially devastating complication after median sternotomy, especially in diabetic obese patients. The optimal technique for sternal closure is unclear in these patients. METHODS The purpose of this prospective randomized study was to compare the incidence of sternal dehiscence after prophylactic sternal weave and figure-of-eight suturing in diabetic obese patients undergoing coronary artery bypass grafting (CABG). The patients were randomly assigned to group A (figure-of-eight closure; n=75) or group B (sternal weave closure; n=75). RESULTS There were 8 cases of sternal dehiscence documented: 7 in group A and 1 in group B. In group A, 5 patients had noninfectious sternal dehiscence and 2 patients underwent reoperation because of sternal dehiscence with mediastinitis. Also, 1 of the noninfected patients had deep-seated pain with a feeling of bony crepitus and needed reoperation. The other 4 patients in group A and 1 patient with noninfectious sternal dehiscence in group B were given chest binder support. Pain and bony crepitus decreased in the follow-up period of 1 year. Sternal dehiscence rates were 9.3% in group A and 1.3% in group B. Sternal dehiscence was significantly lower in group B (p<0.05). CONCLUSIONS Prophylactic sternal weave closure of median sternotomy reduces morbidity from sternal dehiscence in diabetic obese patients undergoing CABG.

The effects of zoledronic acid on neointimal hyperplasia: a rabbit carotid anastomosis model.

OBJECTIVE The aim of the present study was to investigate the effect of zoledronic acid (ZA), as a matrix metalloproteinase inhibitor, on neointimal hyperplasia in rabbit carotid anastomosis model. METHODS New Zealand male rabbits were divided into two groups as placebo and treatment groups in this experimental study. After anesthesia, the right carotid artery of each rabbit was end-to-end anastomosed with an 8/0 polypropylene suture. Left carotid artery was kept as control without any operation. Placebo group (n=6) received phosphate buffered saline (PBS) (0.5mL/kg/day/s.c.) for 28 days postoperatively, whereas ZA group (n=6) received ZA (100 µg/kg/day/s.c.) for the same period. After sacrification, the anastomosed and control arteries were isolated. Morphometric and immunohistochemical examinations were performed. Statistical analyses of morphometric and immunohistochemical data were performed using two-way ANOVA and Chi-square test respectively. RESULTS In PBS group, vascular injury in the anastomosed artery significantly increased the intimal area (anastomosed: 112.51±61.18 µm(2)*1000 vs. control: 22.62±4.26 µm(2)*1000, p<0.01) and intima/media index (anastomosed: 0.347±0.29 vs. control: 0.075±0.01, p<0.05) compared to control artery. ZA significantly reduced the intimal area (39.29±18.21 µm(2)*1000 , p<0.01) and intima/media index (0.112±0.07, p<0.05) compared to PBS group. Additionally, α-smooth muscle actin immunopositivity was found significantly decreased in anastomosed arteries from ZA group (ZA: 2.33±0.52 vs. PBS: 3.50±0.5, p<0.05). Moreover, intensive gelatinase (MMP-2 and MMP-9) immunoreactivities were clearly seen in anastomosed arteries compared to control arteries from PBS group. ZA apparently decreased immunopositivities for gelatinases in anastomosed arteries. CONCLUSION ZA might be a promising agent for prevention of neointimal hyperplasia, which is the most significant cause of graft failures in late postoperative period.

The Transseptal Approach to the Mitral Valve During Multivalvular Surgery

Abstract  Aim: We investigated the short and mid‐term outcome of the transseptal approach to the mitral valve during multivalvular surgery. Methods: Within a three‐year period ending in May 2010, we used the transseptal approach in performing mitral valve surgery in 62 patients. Procedures performed were: mitral valve replacement and tricuspid annuloplasty in 40 patients, both aortic and mitral valve replacement with tricuspid annuloplasty in 13 patients, mitral valve and tricuspid valve replacement in eight patients and mitral valve repair and tricuspid annuloplasty in addition to coronary artery bypass surgery in one patient. Results: There were no complications associated with the transseptal approach. There were no conduction abnormalities, nor were there any procedure‐related deaths. Conclusion: We conclude that use of the transseptal approach for mitral valve operations is simple and safe in patients necessitating right atriotomy for concomitant procedures. (J Card Surg 2011;26:472‐474)

The effect of resveratrol on intimal hyperplasia and endothelial proliferation of rabbit carotid artery anastomosis

OBJECTIVES We assessed the effect of resveratrol on intimal hyperplasia and endothelial proliferation after its use for carotid artery anastomosis in rabbits. METHODS Fourteen New Zealand-type male rabbits, weighing a mean of 2-3 kg were selected randomly. Their right carotid arteries were transected and anastomosed side by side using 8/0 polypropylene. The rabbits were divided into two groups with seven in each group. While the rabbits in the first group were accepted as the Control group, the rabbits in the second group were given resveratrol (1 mg/kg/day) for 14 days intravenously. At the end of the 28th day, all the carotid artery segments that were transected and anastomosed and the left carotid arteries that did not undergo surgery were removed and evaluated histologically. RESULTS The results of histological evaluation were as follows: lumen diameter (P <0.001) and lumen area (P <0.05) of the Resveratrol group were larger than those of the Control group, intimal thickness (P <0.05) and media thickness of the Resveratrol group (P = 0.04) were thinner than those of the Control group, and intima/media ratio of the Control group was found to be greater than that of the Resveratrol group (P = 0.002). CONCLUSIONS Resveratrol can prevent intimal hyperplasia and endothelial proliferation following surgical anastomosis.

Advanced treatment of acute femoropopliteal bypass graft occlusion with Fogarty catheter guidance

Purpose The guiding role of the Fogarty catheter was investigated among patients suffering from limb ischemia due to acute femoropopliteal bypass graft occlusion. Methods A total of 27 patients with a history of femoropopliteal bypass operation who was admitted with acute limb ischemia were enrolled in this retrospective study. In cases in which the Fogarty catheter could not be passed through the popliteal anastomosis, the popliteal region was explored and a new bypass or patch plasty was performed for the distal anastomosis. The cases in which the blood circulation was observed in the graft, but in which the Fogarty catheter balloon was stuck in the native vessels on the proximal and distal side of the graft and the balloon could be withdrawn by deflation, were referred to conventional angiography. The stenosis observed in native vessels was managed by endovascular stent grafting and/or balloon dilatation. Findings Graft patency was achieved in all patients. In 11 patients, conventional angiography was implemented following embolectomy. In these patients, all the occlusions found as significant on angiography were removed by percutaneous transluminal angioplasty. Conclusion Effective use of Fogarty catheter is safe in acute femoropopliteal bypass graft occlusions and in particular, in the planning of further treatment following thrombectomy.

Bedside Surgery to Treat Patent Ductus Arteriosus in Low-Birth-Weight Premature Infants

Background Patent ductus arteriosus (PDA) is commonly seen in premature infants with low birth weights (LBW). It is a condition that has high mortality and morbidity rates. Early closure of the ductus arteriosus may require surgery or medical treatment. However, the decision of first medical approach for symptomatic PDA closure is still debated. In this study, we compared the surgical and medical treatments for the closure of PDA in premature LBW infants. Methods This study included 27 premature infants whose birth weights were lower than 1500 g, who were born in the period between 2011 and 2013 and had symptomatic PDA. Patients were separated into two groups: groups A and B. Group A included patients whose PDAs were closed with medical treatment (n = 16), and group B included patients who had undergone surgical operations for PDA closure (n = 11). Results There were no statistically significant differences between groups A and B when the groups were compared in terms of birth weight, gestational age, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), sepsis, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and pneumothorax. Although the mortality rate was determined to be lower in group B (2 out of 11, 18.1%) than in group A (7 out of 16, 43.7%), no statistically significant difference was found between the two groups. A statistically significant increase was determined in the incidence of kidney function loss in patient group that received Ibuprofen, a medical treatment, in comparison to the patients who had surgery. Conclusion In conclusion, surgery is a safe method to repair PDA in premature LBW infants. Although there is no remarkable difference between surgery and medical treatment, we suggest that a surgical approach may be used as a first choice to repair PDA considering the lower rate of mortality and morbidity and higher rate of closure compared to medical treatment.

Catheter-Directed Thrombolysis in a Patient with Severe Atherosclerotic Stenosis Presenting with Acute Limb Ischemia: Case Report

Acute leg ischemia is a clinical condition that can result in loss of the extremity or death. Depending on the clinical picture, patients with acute leg ischemia can be treated with emergent surgical revascularizaton or catheter-directed thrombolysis. This paper presents a case of acute leg ischemia treated with catheter-directed thrombolysis.

Infected Giant Lymphangioma Circumscriptum Treated With a Combination Therapy

Lymphangioma circumscriptum is an uncommon benign disorder of skin and subcutaneous tissues characterized by dilated lymphatic channels. It is an uncommon vascular tumor and it rarely becomes infected. We report a 20-year-old man who had an infected giant tumor in his left thigh. After an extensive resection and radiofrequency energy therapy, he recovered well with an acceptable cosmetic result. We followed up the patient for 2 years without any recurrence.