Murat Tavlasoglu

Hydroxyethyl starch 6%, 130/0.4 vs. a balanced crystalloid solution in cardiopulmonary bypass priming: a randomized, prospective study

BackgroundSince the advent of cardiopulmonary bypass, many efforts have been made to avoid the complications related with it. Any component of the pump participates in occurrence of these adverse events, one of which is the type of prime solution. In this study, we aimed to compare the effects of 6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte solution on postoperative outcomes following coronary bypass surgery.MethodsTwo hundred patients undergoing elective coronary bypass surgery were prospectively studied. The patients were randomized in to two groups. First group received a balanced electrolyte solution and the second group received 6% hydoxyethyl starch 130/0.4 as prime solution. The postoperative outcomes of the patients were studied.ResultsThe mean age of the patients was 61.81 ± 10.12 in the crystalloid group whereas 61.52 ± 9.29 in the HES group. There were 77 male patients in crystalloid group and 74 in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental effects on renal and pulmonary functions. The intensive care unit stay and postoperative hospital length of stay were shorter in hydroxyethyl starch group (p < 0.05 for each). Hydroxyethyl starch did not increase postoperative blood loss, amount of blood and fresh frozen plasma used, but it decreased platelet concentrate requirement. It did not have any effect on occurrence of post-coronary bypass atrial fibrillation (p > 0.05).Conclusions6% hydroxyethyl starch 130/0.4 when used as a prime solution did not adversely affect postoperative outcomes including renal functions and postoperative blood transfusion following coronary bypass surgery.

Guillain–Barré syndrome after coronary artery bypass surgery

A case of the Guillain-Barré syndrome occurring after otherwise uneventful cardiac surgery using cardiopulmonary bypass is presented. Though the Guillain-Barré syndrome has been reported after surgical procedures, there are very few case reports after cardiopulmonary bypass surgery in the literature. The exact pathophysiological cause of the syndrome is still unknown. However, the most widely accepted hypothesis is that the syndrome is the result of an immune-mediated process. Cardiac surgery may be a trigger for immune-mediated response.

Transapical closure of mitral paravalvular leakage

Paravalvular leakage after mitral valve surgery is a rare complication. The cause is usually the rupture of sutures. Although it may be asymptomatic, serious haemodynamic changes, heart failure and even death may be observed. Surgical treatment modalities have considerable morbidity rates. Over the last few years, new treatment strategies for paravalvular leakage have been described and recommended, particularly in patients with high surgical risk. We present the successful mitral paravalvular leakage closure by an Amplatzer duct occluder using the transapical approach in this article.

Evaluation of Skill-Acquisition Process in Mitral Valve Repair Techniques: A Simulation-Based Study

INTRODUCTION Increased patient awareness, duty-hour restrictions, escalating costs, and time constraints in the operating room have revolutionized surgical education. A bovine heart model was designed for training in mitral valve repair procedures. In this article, we aimed to share our experience with this model and to test the validity of simulation with respect to skill acquisition during the training course. METHODS After reviewing instructional video recordings of mitral valve repair techniques, 5 junior residents (first and second year) and 5 senior residents (year 4 or higher), who had no experience in mitral valve repair surgery previously, performed mitral valve repair techniques on bovine heart model in a three-month period. Nine different internet videos demonstrating surgical techniques were watched prior to performance in each case. Different text books were studied before the study course. Following repair in each case, the left ventricle of each bovine heart was statically pressurized, the coaptation depth was measured, and the regurgitation (if any) was scored. Each performance was recorded. At the end of the study, video records were evaluated in a blind fashion by 3 different surgeons experienced in mitral valve repair techniques. The monthly scores obtained were statistically analyzed. RESULTS The mean coaptation depth values measured on a monthly basis were as follows: 2.75±0.63, 4.90±0.91, and 6.55±0.88 for the junior residents and 4.30±0.65, 5.45±0.68, and 7.00±0.64mm for the senior residents. Regurgitation scores noted were 2.20±0.52, 1.65±0.58, and 0.10±0.30 for the junior residents and 1.50±0.60, 0.65±0.67, and 0.70±0.65 for the senior residents During the study period, the practice improved in terms of the aforementioned parameters in both groups (p<0.05). CONCLUSIONS This simulation model of mitral valve repair helped in skill acquisition on monthly basis in both resident groups.

Acute myocardial infarction after prednisolone administration for the treatment of anaphylaxis caused by a wasp sting : online article - case report

BACKGROUND Wasp stings have been demonstrated to cause a wide spectrum of allergic reactions from localised reactions to anaphylaxis. Acute coronary syndromes have been described as potential complications of anaphylactic reactions or some of the drugs used for the treatment of anaphylaxis. We know of only a few cases reported of acute myocardial infarction (MI) following corticosteroid administration or anaphylaxis in subjects with normal coronary arteries. If it exists, underlying subclinical coronary atherosclerosis may become clinically evident. CASE REPORT A 20 year-old male with anaphylaxis due to a wasp sting, complicated by acute ST-elevation MI after intravenous methyl prednisolone administration, is the subject of this report. He was admitted to our emergency service for dizziness, blurred vision, presyncope and mild respiratory distress 10 minutes after the wasp had stung him on the nape of the neck. Six to seven minutes after administration of prednisolone, the patient complained of typical chest pains. A high posterolateral MI with mild mitral regurgitation were seen on examination. He was treated conservatively with aspirin and heparine. Coronary angiography and intravascular ultrasound imaging, performed 10 days later, showed no evidence of obstructive coronary artery disease. CONCLUSION Although reduced coronary perfusion, local histamine release-induced coronary vasospasm or severe hypoxia have been suggested, the pathophysiology remains unclear. Acute STEMI may be a rare but clinically important complication of a wasp sting, anaphylaxis or the corticosteroid used for its treatment, even in young adults with normal coronary arteries. Therefore, physicians should be aware of such serious complications in order to diagnose them early.

Minimally invasive pediatric surgery in uncomplicated congenital heart disease

Background: We aimed to highlight the use of a minimally invasive approach in uncomplicated congenital heart surgery. Patients and methods: We investigated retrospectively 32 children below 10 years of age who underwent elective closure of ostium secundum type (n = 27), sinus venosus type (n = 4) and ostium primum type (n = 1) atrial septal defects through a limited skin incision and partial lower sternotomy between August 2001 and December 2008. All patients had cannulation through the same incision for cardiopulmonary bypass. Results: A pericardial patch was used to close the defect in 8 patients and direct suturing in 24. The mean time from the skin incision to cannulation was 56 ± 23 min. Total bypass time was 27 ± 12 min, and crossclamp time was 15 ± 8 min. Mean length of hospital stay was 4 ± 2 days. We did not encounter any complications or mortality. Conclusions: A minimally invasive approach, consisting of a limited skin incision and partial lower sternotomy, is a safe, reliable, and cosmetically advantageous method in uncomplicated congenital heart disease surgery, which can be performed widely, and may replace the standard approach without increasing mortality and morbidity.

Efficacy of thermoreactive nitinol clip implantation in reconstruction of sternal dehiscence.

BACKGROUND Sternal dehiscence is a severe complication of open heart surgery. Reinforced wiring, a system of reinforced sternal closure, fixation of a rigid plate, and implantation of thermoreactive nitinol clips (TRC) are some surgical procedures used. The aim of this study was to evaluate the role of TRC for secondary sternal reconstruction. METHODS Of 1198 patients who underwent their operations via median sternotomy in 2 separate medical centers, sternal dehiscence was observed in 16 patients overall (1.33%). The mean (SD) age of the patients was 64.06 ± 9.18 years (range, 40-77 years). Sternal dehiscence was diagnosed in all patients between the fifth and 30th postoperative days. RESULTS TRC were implanted in all of the patients who developed sternal dehiscence (16 patients). One patient developed severe respiratory failure, became ventilator dependent, and died from pneumonia on postoperative day 24. The other 15 patients were discharged without complications. Postoperative follow-up of the surviving patients revealed adequate and satisfactory sternal stability. CONCLUSION Implantation of TRC is an effective and easy method for fixing the sternum and can be performed rapidly and securely.

The combination of percutaneous transapical and transseptal closure of cardiac apex and prosthetic mitral paravalvular leak with loop technique

Article history: Received 11 October 2015 Accepted 18 October 2015 Available online 19 October 2015 Firstly, we decided to try the percutaneous transapical approach with a needle without left minithoracotomy. Under general anesthesia, we performed coronary angiography in order to not puncture the left anterior descending artery in apical region (Fig. 2). After that, under TEE and fluoroscopic angiographic guidance, transapical cannulation of the left ventricle from the sixth intercostal area and midclavicular region with a needle was performed and a 6 F sheath was inserted to

Skill acquisition process in vascular anastomosis procedures: a simulation-based study.

OBJECTIVES There is growing evidence that practice on simulation models can improve technical skills in surgery. The aim of this study is to assess the effects of our tissue-based simulation model of vascular anastomosis on skill acquisition. METHODS Five junior (Group I) and five senior (Group III) cardiovascular surgery residents, and five surgeons from different surgical departments (Group II) attended the study. A total of 180 vascular anastomoses on a bovine heart simulation model were performed in a 3-month period; each group performed 20 anastomoses per month (each participant in each group conducted four anastomoses per month). The anastomoses were evaluated according to criteria including, duration of the procedure, existence of anastomotic leak, additional suture requirements, matching between graft diameter and arteriotomy length, patency rates and inadvertent posterior wall injuries. Each practice was recorded with a video camera and eventually reviewed by three cardiovascular surgeons, who were blinded to groups. Results were compared for analysing the skill acquisition process in each group. RESULTS The mean anastomosis time (Group I: 22.25 ± 2.02, 18.10 ± 0.78, 15.00; Group II: 17.05 ± 1.39, 15.45 ± 0.82, 13.00 ± 0.79; Group III: 13.65 ± 0.67, 11.45 ± 1.14, 10.50 ± 1.10) and additional suture requirements (Group I: 1.95 ± 0.68, 1.30 ± 0.80, 1.00 ± 0.32; Group II: 1.80 ± 0.41, 1.45 ± 0.60, 1.45 ± 0.60; Group III: 0.65 ± 0.48, 0.40 ± 0.50, 0.40 ± 0.50) decreased gradually (P < 0.0001 for each) in all groups. There was statistically significant improvement over time in anastomotic leakage (Group I: 90, 65, 20%; Group II: 50, 25, 5%; Group III: 20, 25, 5%), match between the arteriotomy and the graft (Group I: 35, 25, 75%; Group II: 60, 45, 85%; Group III: 85, 65, 95%), posterior wall injury (Group I: 70, 50, 15%; Group II: 50, 30, 5%; Group III: 30, 30, 5%) and patency (Group I: 45, 15, 75%; Group II: 60, 50, 95%; Group III: 80, 85, 95%) in all groups, except for the occurrence of anastomotic leaks and patency rates in the senior cardiovascular resident group (Group III). CONCLUSIONS Although the most significant improvement was observed in Group I, all groups demonstrated improved skills with the simulation model. Therefore, it can be suggested that anastomosis training on tissue-based simulation models may be beneficial for the skill acquisition process.

Can valved mitral prosthesis be implanted within all kinds of the mitral annuloplasty rings

This article has been accepted for publication and undergone full peer review but has not beenthrough the copyediting, typesetting, pagination and proofreading process which may lead todifferences between this version and the Version of Record. Please cite this article as an ‘Accepted Article’, doi: 10.1002/ccd.24553