Selami Gürkan

Effect of standard versus patient-targeted in-patient education on patients' anxiety about self-care after discharge from cardiovascular surgery clinics : cardiovascular topic

Abstract We compared standard and patient-targeted in-patient education in terms of their effect on patients’ anxiety. One hundred and ninety-eight patients who were hospitalised for coronary artery bypass surgery were given standard education (group 1) or individualised education (group 2) on the management of their healthcare after discharge. Patients in group 2 were assessed on the patient learning needs scale and were given education according to their individual needs. The level of anxiety was measured by the state–trait anxiety inventory. Anxiety scores were significantly lower in group 2 than group 1 after education (p < 0.001). While state anxiety did not change after education in group 1 (p = 0272), it decreased significantly in group 2 (p < 0.001). For cardiovascular surgery patients, patient-targeted in-patient education was more effective than standard education in decreasing anxiety levels, therefore the content of the education should be individualised according to the patient’s particular needs.

Comparison of endothelial function of coronary artery bypass grafts in diabetic and nondiabetic patients: Which graft offers the best?

Objective: Diabetes associated endothelial dysfunction, which determines both long and short term graft patency, is not uniform in all coronary artery bypass surgery (CABG) grafts. Herein this study, we aimed to investigate the degree of endothelial dysfunction in diabetic radial artery (RA), internal mammarian artery (IMA) and saphenous vein (SV) grafts in vitro tissue bath system. Methods: This is a prospective experimental study. Fifteen diabetic and 15 non-diabetic patients were included to the study. A total number of 96 graft samples were collected; 16 graft samples for each graft type from both diabetic and non-diabetic patients. Arterial grafts were harvested with pedicles and SV grafts were harvested by ‘no touch’ technique. Vasodilatation response of vascular rings to carbachol, which induces nitric oxide (NO) mediated vasodilatation, was designated as the measure of endothelial function. Results: The IMA grafts had the most prominent NO mediated vasodilatation in both diabetic and non-diabetic patients, concluding a better preserved endothelial function than SV and RA. The ‘no-touch’ SV and RA grafts had similar vasodilatation responses in non-diabetic patients. In diabetic patients, on the other hand, RA grafts exhibited the least vasodilatation response (ie. worst endothelial function), even less vasodilatation than ‘no touch’ SV grafts (p<0.0001). Conclusion: Deteriorated function of RA grafts in diabetic patients, even worse than SV grafts made evident by this study, encourages the use of ‘no touch’ technique as the method of SV harvesting and more meticulous imaging of RA before its use as a graft in diabetic patients.

Body mass index as a determinant of postoperative morbidity

BACkGRouND: The impact of obesity on postoperative mortality and morbidity in coronary artery bypass grafting (CABG) operations is a widely studied but poorly defined topic. oBjECTIVE: To investigate the effect of body mass index (BMI) on inhospital mortality and morbidity after isolated CABG surgery. METhoDS: Prospectively collected data of a series of 1057 consecutive patients who underwent on-pump isolated CABG surgery were retrospectively analyzed. Patients were divided into five groups according to WHO BMI categorization (defined as underweight [BMI <20 kg/m2]; normal weight [BMI ≥20 kg/m2 to <25 kg/m2]; overweight [BMI ≥25 kg/m2 to <30 kg/m2]; obese [BMI ≥30 kg/m2 to <35 kg/m2]; and morbidly obese [BMI ≥35 kg/m2]). RESulTS: Of 1057 patients, 13 patients (1.2%) were underweight, 298 (28.2%) were normal weight, 462 (43.7%) were overweight, 218 (20.6%) were obese and 66 (6.2%) were morbidly obese. The mean age was significantly lower in underweight patients, who were also more likely to be male. In contrast, obese and morbidly obese patients were older, and more likely to have comorbidities such as diabetes and hypertension. The incidence of postoperative bronchodilator use (P<0.001), leg wound infection (P=0.038), sternal dehiscence (P=0.039) and development of new-onset atrial fibrillation (P<0.001) was significantly higher in obese and morbidly obese groups. In contrast, postoperative prolonged ventilation (P<0.001), need for blood transfusions (P<0.001) and revision for bleeding (P=0.041), as well as gastrointestinal complications (P<0.001), were significantly higher in underweight patients. Multivariate logistic regression analysis showed that female sex, older age and diabetes mellitis, but not BMI, were independent risk factors for early mortality after CABG surgery. CoNCluSIoN: No effect of BMI on early postoperative mortality after CABG surgery could be demonstrated. However, in terms of morbidity, postoperative bleeding and revision for bleeding were increased in underweight patients while sternal dehiscence, wound infections and occurrence of atrial fibrillation were increased in obese and morbidly obese patients.

Inflammatory Mediators Across the Spectrum of Ankle-Brachial Index

Aim: Peripheral artery disease (PAD) is a manifestation of atherosclerosis with poor prognosis. It is generally complicated by vascular calcification, which is located either in the intima as patchy infiltrates; or circumferentially in the media, also known as medial arterial calcification (MAC). Obstructive PAD is reflected by low anklebrachial index (ABI ≤ 0.9), whereas MAC is revealed by high ABI (ABI > 1.4). Considering the increase in cardiovascular mortality at both ends of the ABI spectrum, this study aimed to explore the underlying pathology through cytokines with established prognostic significance; namely pentraxin-3(PTX3), high sensitivity C-reactive protein (hsCRP), copeptin, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), NT-proBNP, and neopterin. Methods: We categorized 180 patients with previous multivessel coronary artery bypass grafting surgery into three groups based on their ABI measurements; 60 patients with ABI ≤ 0.9, 60 patients with ABI within 0.91 and 1.4 (normal ABI), and 60 patients with ABI > 1.4 constituted the “PAD,” “normal,” “MAC” groups, respectively. The circulating levels of the biochemical markers were determined. Results: In the PAD group, the cytokine levels with predominantly proatherogenic actions such as PTX3, hsCRP, copeptin, and sTREM-1 were increased and these cytokine levels declined as the ABI increased. In the MAC group, the cytokine concentrations with pleiotropic actions such as NT-proBNP and neopterin increased and; NT-proBNP and neopterin concentrations decreased as ABI decreased. The linear regression analysis revealed that neopterin (β = 0.72), PTX3 (β = −0.32), and copeptin (β = −0.48) were independent predictors of ABI. Conclusions: These findings suggest that different inflammatory pathways influence the pathology at the opposing ends of the ABI spectrum. Consequently, we suggest that PTX3, copeptin, and neopterin are promising biomarkers for future research.

Left atrial myxoma combined with coronary artery disease in an elderly patient

Cardiac myxoma associated with coronary artery disease is a rare pathology in an elderly patient. Herein we present an 81-year-old woman undergoing simultaneous surgical treatment for left atrial myxoma combined with coronary artery disease. The postoperative course of the patient was uneventful. The initial removal of mass should be performed to prevent systemic embolization of tumor fragments.

The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass Surgery

PURPOSE Beta-blocker use is common in the cases with coronary artery bypass surgery. According to the literature, beta-blockers have positive effects but may cause erectile dysfunction (ED). The most commonly used beta-blockers in ischemic cardiac disease are nebivolol and metoprolol. In our clinic, we aimed to compare the effects of nebivolol and metoprolol succinate on ED in the sexually active cases with coronary artery bypass surgery. METHODS In our clinic, a total of 119 patients with coronary artery bypass surgery were included in the study. International Index of Erectile Function (IIEF-5) Test was used to evaluate whether the patients had ED and to grade the cases. RESULTS No significant difference was found in terms of anti-ischemic efficacy between metoprolol succinate and nebivolol in the postoperative period; however, the incidence of any grade ED was %85.96 in Group 1, %83.87 in Group 2. This difference was considered as statistically significant (p = 0.036). CONCLUSION Beta-blocker use increases the risk of ED in cases with ischemic cardiac disease. We suggest that the complaints of ED could be less frequent with nebivolol use in sexually active cases with ischemic cardiac disease.

Sağ Sinüs Valsalva’dan Çıkan Sol Ana Koroner Arter Anomalisi

Sag sinus Valsalva’dan cikan sol ana koroner arter anomalisi, oldukca nadir gorulen bir konjenital anomalidir. Tamamen semptomsuz olabildigi gibi, egzersiz ile olusan gogus agrisi ve bayilma, miyokart enfarktusu ve ani olum gibi ciddi klinik tablolar ile de ortaya cikabilir. Yazimizda, sol ana koroner arterin sag sinus Valsalva’dan cikis anomalisi sunulmaktadir.

Combined Spinal-Epidural Anesthesia or Local Anesthesia + Sedoanalgesia in Abdominal Aortic Aneurism Repair?Combined Spinal-Epidural Anesthesia or Local Anesthesia + Sedoanalgesia in Abdominal Aortic Aneurism Repair?

Objective: Anesthesia for the repair of abdominal aortic aneurism can be performed with different modalities of anesthesia or their combinations. The risk level for the morbidity and mortality of the patients, is increased in geriatric patients with the existence of accompanying pathology. To compare two different anesthesia methods (local anesthesia and sedation vs combined spinal and epidural anesthesia) for the repair of endovascular aneurism in a geriatric patient.

Vasodilation Responses to Non-Selective α-Adrenergic Blockage of Coronary Bypass Grafts in Diabetic and Non-Diabetic Patients: In Vitro Study

BACKGROUND Adrenergic tonus is increased in atherosclerotic coronary arteries. In this study, we aimed to demonstrate in vitro effects of phentolamine, a reversible nonselective alpha (α) adrenergic blocker, on coronary artery bypass grafts (CABG) and compare its effects in diabetic and nondiabetic patients. METHODS A total number of 30 patients (15 diabetic and 15 nondiabetic) who were assigned to elective CABG surgery were enrolled into the study. For both groups of patients, 16 internal mammarian artery (IMA) samples, 16 saphenous vein (SV) samples and 16 radial artery (RA) samples were collected and studied in the tissue bath system. The vasodilatation responses to increasing doses of phentolamine were recorded. RESULTS When grafts were compared in terms of amount of vasodilatation to phentolamine, IMA had the most prominent vasodilatation followed by RA and SV respectively. Although the vasodilatation responses in nondiabetic patients were numerically higher than diabetic patients, there was no statistically difference between the groups. CONCLUSION Phentolamine, a nonselective α adrenergic blocker, is proven to have equal vasodilatory effects in diabetic and nondiabetic CABG grafts and can safely be used both intravenously and topically in the perioperative period.

Semirigid band annuloplasty.

We appreciate the interest showed by Polat and Polat [1] in our article [2]. As they noted, preoperative use of corticosteroids and continuous postoperative steroid therapy in patients with Behçet’s disease (BD) is essential to improve treatment outcome for valve surgery [3]. In our patient, we also prescribed prednisolone for 3 weeks prior to aortic valvuloplasty and maintained the prednisolone administration for 6 months after the operation to sustain a low-inflammation state [2]. As we suggested, early diagnosis is crucial for initiating immunosuppressive therapy before valve surgery to improve the long-term outcome for the treated valve. With regard to coagulation, the patient in our report did not experience any thrombotic event before or after operation. The baseline preoperative coagulation study showed normal findings (prothrombin time international normalized ratio, 1.03; activated partial thromboplastin time 35.8 seconds). After the aortic valvuloplasty, the patient was briefly treated with warfarin for 1 week, after which the treatment was changed to an antiplatelet drug (triflusal). As Polat and Polat [1] suggested, the potential for the development of thrombosis in BD patients is well known. Endothelial lesions in BD patients, increased procoagulant activity, and hypofibrinolysis have been suggested as the likely causes for potential thrombosis development [4]. As Polat and Polat also noticed, our patient was diagnosed with BD shortly before operation. Because of the patient’s relatively young age, it is difficult to think of BD as a cause of the valve lesion. In addition, this patient lacked the symptoms to fulfill the International Study Group criteria [5]. However, his characteristic echocardiographic findings, along with elevated ESR and human leukocyte antigen-B51 positivity, appeared to be sufficient for a diagnosis of BD. If the diagnosis of BD had been delayed in this patient, he may have developed other typical symptoms and signs of BD in the future.