Ozan Erbasan

Outcomes and Readmissions After Continuous Flow Left Ventricular Assist Device: Heartmate II Versus Heartware Ventricular Assist Device.

INTRODUCTION Donor organ shortage is still a problem for heart transplantation. Only 10% of patients in waiting list undergo heart transplantation. Over the last 5 years, 2 different continuous flow pumps, the HeartMate II and the HeartWare, have been successful clinically in the alternative treatment of patients with end-stage heart disease. METHODS Fifty-five patients underwent left ventricular assist device implantation between 2011 and 2014. Patients were followed on pump support for complications and intraoperative outcomes. Potential device-related complications include infections, bleeding liver dysfunction, renal dysfunction, right ventricular failure, stroke, thromboembolism, gastrointestinal bleeding, and wound infection. RESULTS The only preoperative significant difference between groups in the study was age; the Heartmate II group were significantly older than Heartware group. There were no differences in gender, body mass index, or body surface area. The Heartware has a better 1-year survival rate, although the difference was not significant. Patients with Heartmate II had a higher incidence of gastrointestinal bleeding and driveline infection. The Heartware group had a higher incidence of stroke and pump thrombosis. CONCLUSIONS The Heartmate II and Heartware are comparable in most respects such as survival, intraoperative features, and major complications.

Primary intravascular synovial sarcoma: case report.

Synovial sarcoma (SS), a mesenchymal spindle cell tumor, displays variable epithelial differentiation, including glandular formation, and features a specific chromosomal translocation, t(X;18)(p11;q11). SS accounts for 5% to 10% of soft-tissue sarcomas. These tumors occur mostly in the joints, especially near the knee, but they also occur in other locations. Primary intravascular SS (IVSS) are extremely rare; only 6 well-documented cases have been reported in the English literature. We describe a new case of primary IVSS of the superior vena cava (SVC) in a 16-year-old boy. A transthoracic echocardiogram confirmed a large (4.8 × 4.6 cm) circumscribed mass filling the right atrium, as well as a moderate pericardial effusion. The mass extended from the SVC to the tricuspid valve but did not prevent valve coaptation. Surgery via a transatrial approach revealed a huge mass (8 to 12 cm) attached to the SVC via a 5-mm pedicle. The tumor was excised, and the patient experienced an uneventful postoperative course. Fluorescence in situ hybridization analysis revealed the presence of the SS-specific translocation.

Surgical treatment of left ventricular aneurysms: a comparison of long-term follow-up of left ventricular function for classic aneurysmectomy and endoaneurysmorrhaphy techniques.

OBJECTIVE Myocardial infarction may be complicated by the formation of a left ventricular (LV) aneurysm that distorts the normal elliptical geometry of the ventricle to produce a dilated spherical ventricle with limited contractile and filling capacities. One of the consequences is congestive heart failure, which may be refractory to medical therapy and require surgical treatment. The aim of this study was to evaluate LV function in the late term following repair of LV aneurysm. METHODS Ninety-seven patients underwent repair of postinfarctional LV aneurysms. Sixty-one patients (62.9%) underwent classic aneurysmectomy, and 36 patients (37.1%) had endoaneurysmorrhaphy. The mean age (+/-SD) of the 87 men (89.7%) and 10 women was 55.98 +/- 8.59 years. Coronary surgery was performed in 82 patients (84.5%), with a mean of 1.34 +/- 0.77 grafts/patient. The mean preoperative ejection fraction (EF) was 39.74% +/- 8.79% (classic, 39.92% +/- 8.90%; endoaneurysmorrhaphy, 39.43% +/- 8.61%; difference not statistically significant [NS]). Fifty-five patients (56.7%) had angina of Canadian Cardiovascular Society class III to IV (classic, 55.7%; endoaneurysmorrhaphy, 58.3%; NS), 31 patients (31.9%) were in New York Heart Association (NYHA) class III to IV (classic, 31.1%; endoaneurysmorrhaphy, 33.3%; NS), and the mean preoperative NYHA functional class was 2.88 +/- 0.74 (classic, 2.83 +/- 0.77; endoaneurysmorrhaphy, 2.97 +/- 0.71; NS). RESULTS The mortality rate at <30 days was 9.8% (n = 6) in the classic aneurysmectomy group and 2.7% (n = 1) in the endoaneurysmorrhaphy group. Long-term follow-up was available for 80 of these patients. During a mean follow-up of 79.3 +/- 37.6 months (range, 6-156 months), 14 patients (17.5%) died of a cardiac-related cause (classic, 8 patients [16.6%]; endoaneurysmorrhaphy, 6 patients [18.7%]; NS). The cardiac-related survival rate was 82.5%. In the first year, at 5 years, and at 10 years, the survival rates of the patients who underwent classical aneurysmectomy were 98.8%, 93.5%, and 76.1%, respectively, and the rates for patients who underwent endoaneurysmorrhaphy were 100%, 93.0%, 71.2%, respectively (P = .2). In the follow-up patient population, the mean preoperative EF was 40.21% +/- 9.44% in the classic aneurysmectomy group and 39.34% +/- 8.61% in the endoaneurysmorrhaphy group. Postoperatively, mean EFs increased to 44.24% +/- 9.50% and 43.80% +/- 8.81%, respectively, at the last follow-up. NYHA functional class changed from 2.79 +/- 0.77 preoperatively to 1.60 +/- 0.73 postoperatively in the classic aneurysmectomy group and from 2.97 +/- 0.71 preoperatively to 1.34 +/- 0.54 postoperatively in the endoaneurysmorrhaphy group. There was no significant difference in hospital readmissions for cardiac causes (classic, 27.1%; endoaneurysmorrhaphy, 31.2%). CONCLUSION LV aneurysm can be repaired with acceptable surgical risk. Surgical treatment of LV aneurysm is associated with an improvement in long-term survival and symptoms.

An unusual clinical state: true ulnar artery aneurysm in a five-year old girl

We report the case of a 5-year old girl, who presented with a true ulnar artery aneurysm, and the aetiology, clinical presentation and treatment of the disease.

Extracorporeal Membrane Oxygenation Therapy-Assisted Cardiopulmonary Resuscitation and Successful Bridging to Cardiac Retransplant for Cardiac Allograft Vasculopathy

Extracorporeal membrane oxygenation therapy is being used increasingly in different areas. It has become an indispensable assistant to clinicians for hypoxic pulmonary disorders, cardiogenic shock, resuscitation, and during cardiac surgery. In this case report, we describe a patient who is bridged to successful cardiac retransplant under extracorporeal membrane oxygenation therapy support after extracorporeal membrane oxygenation therapy-assisted cardiopulmonary resuscitation.

En az bir yıl takipleriyle birlikte lazer safen ablasyon sonuçlarımız

Objectives: This retrospective study aimed to evaluate the efficacy and durability of endovenous laser ablation with 940 nanometer wavelength with at least one-year follow-up. Materials and methods: Between December 2009 and February 2012, a total of 68 incompetent great saphenous veins and 4 small saphenous veins were treated by endovenous laser ablation, using 940 nanometer wavelengths. Patients underwent standard clinical and duplex follow-up examinations with a mean of 18 months (range 12 to 26 months) after endovenous laser ablation. Patient satisfaction regarding the procedure was assessed with the use of a visual analog scale (range 1 to 100). Results: Post-procedural duplex scans showed total occlusion of the treated great saphenous veins in 56 patients (97%) and sub-total occlusion in 2 (3%) patients. For small saphenous veins, post-procedural duplex scans showed total occlusion in 4 (100%) patients. The average pre-procedure modified clinical picture, eti ology, anatomic distribution and pathophysiology clinical score improved significantly after 12 months. Complica tions from our series included swelling and induration in 3 patients (5%), skin pigmentation in 3 patients (5%). Patient satisfaction with the surgical outcome was 83.17 % (±11.79, n=58). Conclusions: Our results have been satisfying, and this study has reaffirmed the effectiveness and durability of endovenous laser ablation with 940 wavelength in the treatment of great saphenous vein insufficiency.