Şahin Şenay

Effects of N-acetylcysteine on myocardial ischemia-reperfusion injury in bypass surgery

Myocardial ischemia–reperfusion injury may complicate coronary artery bypass grafting (CABG) operations. N-Acertylcysteine (NAC) had antioxidant and microcirculatory effects, and inhibits neutrophil aggregation. The aim of this study was to determine the effects of NAC in limiting myocardial ischemia–reperfusion injury in CABG operations. Twenty patients undergoing elective coronary bypass operation with cardiopulmonary bypass were enrolled and randomly assigned to two groups: a control group operated with a routine CABG protocol, and one where NAC was administered intravenously during the operation (NAC group). Blood samples from coronary sinus for tumor necrosis factor-α assay, myocardial biopsy specimens for chemiluminescent luminol, and lucigenin measurements of reactive oxygen species were taken. The luminol (specific for •OH, H2O2, and HOCl− radicals) and lucigenin (specific for O2•−) levels and the difference ratios after reperfusion were significantly lower in the NAC group. Tumor necrosis factor-α levels increased in the control group but, in contrast, a significant decrease was detected in the NAC group (P < 0.01). Creatine kinase-MB levels at 6 and 12 hours were singnificantly lower in the NAC group (P = 0.02). N-Acetylcysteine has potential effects to limit ischemia reperfusion injury during CABG operations. We believe that its effects on clinical outcome may be more apparent in patients prone to ischemia–reperfusion injury.

The effect of mild left ventricular diastolic dysfunction on outcome after isolated coronary bypass surgery

BACKGROUND Although moderate to severe diastolic dysfunction (DD) seems to be associated with poor prognosis after isolated coronary bypass surgery, the impact of mild DD has not been investigated extensively in this group of patients. AIM We evaluated the prognostic implication of mild left ventricular (LV) DD on outcome after isolated coronary bypass surgery in patients with preserved LV systolic function. METHODS Data from 650 patients undergoing isolated coronary bypass surgery and having records for LV diastolic function between January 2009 and August 2011 was collected retrospectively. DD was classified as mild (grade 1, impaired relaxation), moderate (grade 2, decreased compliance) or severe (grade 3-4, restrictive pattern) depending on mitral inflow wave, tissue Doppler imaging, and pulmonary vein flow wave. Patients with baseline rhythm other than sinus, moderate or severe valvular dysfunction, moderate or severe diastolic dysfunction, and LV ejection fraction lower than 50% were excluded. A total of 472 patients were identified within the database fulfilling the eligibility criteria for this analysis and stratified according to the echocardiographic findings as follows: group 1 comprised patients with normal diastolic function (n = 168); and group 2 was made up of patients with mild DD (impaired relaxation) (n = 304). These groups were compared for perioperative morbidity and mortality. RESULTS The preoperative variables were comparable between groups. The outcome parameters of group 1 was similar compared to group 2 in terms of need for inotropic support (20.2% vs. 16.2%), intra-aortic balloon pump usage (0% vs. 1.4%), mechanical ventilation time (8.94 ± 0.96 h vs. 10.0 ± 0.89 h), reintubation rate (1.8% vs. 1.4%), intensive care unit stay time (24.1 ± 1.4 hvs. 26.2 ± 1.9 h), postoperative renal failure rate (0% vs. 0.3%), postoperative atrial fibrillation rate (10.1% vs. 11.2%), length of hospital stay (7.19 ± 0.45 vs. 6.57 ± 0.14 days), hospital readmission rate (3.1% vs. 3.1%), and mortality (0% vs. 1.6%). CONCLUSIONS The results from this study indicate that mild LV DD is not associated with adverse outcome after coronary bypass surgery in patients with preserved LV systolic function, thus should not be considered as a preoperative risk factor.

Leyla loop: a time-saving suture technique for robotic atrial closure

The longer durations of cardiopulmonary bypass and aortic cross-clamp times remain the disadvantages of robotic or minimally invasive cardiac surgery. For this reason, every small contribution to speeding up these procedures is of the utmost importance. Here, we present a practical, easy and time-saving suture technique for atrial closure. It consists of a hand-made loop at one end of the suture and saves the time otherwise consumed by knotting. It may also be used during conventional or minimally invasive cardiac surgery.

Functional results in aortic root enlargement.

BACKGROUND The hemodynamically efficient valves with effective orifice areas that are used in aortic valve replacement have been positively determined to affect postoperative exercise capacity. The aim of this study was to evaluate the functional effects of aortic root enlargement in the late postoperative period for patients with a small effective orifice area. METHODS Nineteen patients with a small effective orifice area were included in the study. The study group comprised 9 patients who underwent isolated aortic valve replacement with 23-mm St. Jude Medical prosthetic valves and posterior aortic root enlargement. The control group comprised 10 patients in whom 19-mm and 21-mm St. Jude Medical prosthetic valves were implanted without aortic root enlargement. The patients were evaluated in the late postoperative period with echocardiography and cardiopulmonary exercise testing. RESULTS The 2 groups were similar in anthropometric parameter values, follow-up periods, echocardiographic findings, and the gradients at the prosthetic aortic valve at rest; however, the anaerobic threshold, peak oxygen uptake, minute ventilation volume, and walk time were significantly higher in the study group ( P <.05). CONCLUSION The choice of aortic root enlargement for the implantation of a valve with a larger effective orifice area is preferred by most of the surgeons over the implantation of a valve with a smaller effective orifice area. The late postoperative functional capacity of the patient is significantly improved with root enlargement. Surgeons should be encouraged to perform root enlargement in patients with a small effective orifice area, and such surgery may even be performed routinely in these patients.

Transesophageal Echocardiography: Sine Qua Non In Cardiac Surgery

Objective: Intraoperative transoesophageal echocardiography (TEE) performed during cardiac surgery provides information about the cardiac pathology and the surgical repair. The aim of this study is to determine the importance of TEE in surgical decision making phase in patients undergoing cardiac surgery. Material and Method: We reviewed the data for all patients who underwent cardiac surgery and TEE between January 2015 and December 2016. Intraoperative TEE examination was performed before and after the cardiopulmonary bypass (CPB). The data collected related to the type of surgery, preoperative echocardiographic findings, TEE findings before and after CPB and any differences between them were evaluated. Results: A total of 284 patients who underwent cardiac surgery during 2 years period were evaluated using TEE. The initial TEE findings of 15.8% (n=45) of the patients differed from those observed before cardiopulmonary bypass (CPB). The results of the TEE assessments before and after CPB affected surgical decisionmaking in 3.5% (n=10) and 2.5% (n=8) of the cases, respectively Conclusion: Perioperative TEE performed by the anesthesiologist can provide important information, may lead to alterations in the surgical strategy and improve the operative outcomes.

Sutureless aortic valves

We read the article by Mataraci et al.[1] with a great interest. In consistent with our clinical results and literature data, we share the same opinion regarding to the superior hemodynamic consequences of sutureless aortic valves.[2] However, the main advantage of these valves, in our opinion, may be the standardization and reproducibility of valve implantation process. This property may help cardiac surgeons to ensure a high operative quality for aortic valve replacement independently from surgeon factor at least to a certain degree. Moreover, these valves may be the choice during the training period of a surgeon with less experience, or adopting a new surgical access skill such as minimally invasive techniques with ministernotomy or mini-thoracotomy. Thus, adaptation of these valves into our current practice would probably be favorable for cardiac surgeons.

Long Term Results of Valve Sparing Aortic Root Replacement; A Single Center Experience

PP-044 The aim of this study is to investigate the early and midterm results of valve sparing aortic root replacements. Between 1999 and 2013 a total of 7220 patients underwent cardiac operations, 26 of them (0.3%) were valve sparing aortic root replacements. The aortic pathology included either

The Effect of Mild Left Ventricular Diastolic Dysfunction on Outcome After Isolated Coronary Bypass Surgery

OP-114 In this study, we evaluated the prognostic implication of mild left ventricular diastolic dysfunction on outcome after isolated coronary bypass surgery. Data of 650 patients undergoing isolated coronary bypass surgery was collected between January 2009 and August 2011. Diastolic dysfunction