Objective: While a reduced left ventricular ejection fraction (EF) is a well-known risk factor for adverse outcomes following coronary artery bypass grafting (CABG), its specific impact on the immediate post-operative recovery phase, such as the likelihood of an extended hospital stay or the need for mechanical circulatory support, is still not fully understood. Methods: We reviewed the records of 482 patients who underwent isolated CABG at our center in this retrospective cohort study. Patients were stratified into two categories based on their pre-operative EF: those with an EF <40% and those with an EF ≥40%. Our primary focus was observing prolonged hospital stays, defined as lasting more than 6 days. We also examined secondary recovery metrics, including time spent in the intensive care unit (ICU), duration of mechanical ventilation, and the utilization of an intra-aortic balloon pump (IABP). To pinpoint the true independent predictors of a prolonged stay, we applied multivariate logistic regression analysis. Results: Patients entering surgery with an EF <40% (n=25) experienced noticeably longer hospitalizations compared to the higher EF group (median 7 [6–10] days vs. 6 [5–7] days, p=0.001). They also required IABP support at a significantly higher rate (28.0% vs. 5.9%, p<0.001). While these patients tended to spend more time in the ICU, this trend narrowly missed statistical significance (p=0.057). After adjusting for other variables, having an EF <40% remained a strong, independent predictor of a prolonged hospital stay (odds ratio [OR]: 4.42, 95% confidence interval [CI]: 1.67–11.74, p=0.003). In addition, the duration of cardiopulmonary bypass emerged as another independent risk factor for extended hospitalization (OR: 1.007, 95% CI: 1.002–1.012, p=0.008). Conclusion: A reduced pre-operative EF is an independent driver of delayed hospital discharge and a heightened need for mechanical heart support following CABG. Tracking EF provides clinicians with a highly practical tool for anticipating early post-operative challenges and tailoring patient care accordingly.
Objective: Deep vein thrombosis (DVT) is an important cause of venous thromboembolism-associated morbidity and mortality. Chronic exposure to moderate altitude may promote erythrocytosis through adaptive erythropoiesis, whereas elevated low-density lipoprotein (LDL) cholesterol may contribute to endothelial dysfunction and vascular inflammation. This study aimed to determine the frequency of previous DVT and to investigate the association of erythrocytosis and LDL cholesterol with previous DVT in occupationally active adult men living at moderate altitude. Methods: This retrospective cross-sectional study included 200 occupationally active adult men residing at an altitude of approximately 1300–1400 m above sea level. Participants were classified according to the presence or absence of a documented history of previous DVT. Hemoglobin and hematocrit were evaluated as markers of erythrocytosis, whereas LDL cholesterol was evaluated as the principal metabolic variable. Age, smoking status, hypertension, platelet count, white blood cell (WBC) count, red blood cell (RBC) count, and C-reactive protein (CRP) were analyzed as secondary variables. Because of the small number of DVT events and complete separation for hematocrit, univariate Firth-penalized logistic regression was used to identify factors associated with previous DVT. Results: Previous DVT was documented in 7 participants (3.5%). Participants with previous DVT were significantly younger than those without DVT (33.0±5.1 vs. 39.1±8.8 years, p=0.018) and had significantly higher hemoglobin levels (17.83±0.86 vs. 16.88±0.98 g/dL, p=0.027). In univariate Firth-penalized logistic regression, each 1-g/dL increase in hemoglobin was associated with higher odds of previous DVT (odds ratio [OR] 2.94, 95% confidence interval [CI] 1.32–6.71; p=0.009). Elevated hematocrit (≥49%) was present in all participants with previous DVT (100.0% vs. 74.1%). Firth regression provided a finite but highly imprecise estimate for hematocrit ≥49% (OR 5.28, 95% CI 0.62–689.64; p=0.151); the extremely wide CIs reflect sparse events and complete separation. Mean LDL cholesterol levels were similar between groups (122.0±34.3 vs. 121.2±29.6 mg/ dL, p=0.952). Smoking, hypertension, platelet count, WBC count, RBC count, and CRP were not significantly associated with previous DVT (all p > 0.05). Conclusion: A history of previous DVT was identified in 3.5% of this relatively young, homogeneous male population living at moderate altitude. Higher hemoglobin levels were associated with previous DVT in univariate analysis; however, an independent association could not be established because multivariable adjustment, including adjustment for age, was not feasible owing to the small number of events. These findings should therefore be considered exploratory and hypothesis-generating and require confirmation in larger prospective studies.
Objective: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare and life-threatening congenital anomaly. While it typically manifests during early infancy, some patients remain asymptomatic or present later in childhood and adolescence due to well-developed intercoronary collaterals. Therefore, the objective of this study was to evaluate the clinical spectrum, diagnostic features, and surgical outcomes of patients diagnosed with ALCAPA beyond infancy at our center. Methods: A retrospective review was conducted on 35 patients diagnosed with ALCAPA who underwent surgical treatment at our center between January 2012 and January 2025. Out of this cohort, 8 patients diagnosed beyond infancy (older than 12 months) were enrolled in this study to evaluate their clinical spectrum and surgical revascularization outcomes. Results: The age at diagnosis ranged from 2 to 21 years (median: 6.8 years), and all patients were female. Four patients (50%) were completely asymptomatic at presentation. Symptomatic presentations included exertional chest pain (n=1), recurrent vomiting and irritability (n=2), and sudden cardiac arrest with sustained ventricular arrhythmia (n=1). Electrocardiography (ECG) revealed characteristic ALCAPA patterns in 5 patients. Echocardiography demonstrated left ventricular (LV) and right coronary artery (RCA) dilation in all cases, with a mean RCA/aortic annulus ratio of 0.25. Baseline LV systolic dysfunction (ejection fraction: 30–45%) was observed in 4 patients. Surgical management consisted of direct coronary reimplantation (n=6) and the Takeuchi procedure (n=2). Mitral valve repair was performed in 2 patients with structural mitral anomalies. At a mean follow-up of 48 months, all patients were alive and asymptomatic, with full recovery of LV function and resolution of ECG abnormalities within 6–9 months postoperatively. Conclusion: ALCAPA must be considered in the differential diagnosis of unexplained LV dilation or mitral regurgitation across all pediatric age groups. Extensive collateral circulation can mask typical features, leading to atypical presentations or misdiagnosis. Prompt establishment of a dual-coronary system provides a satisfactoryprognosis and facilitates complete myocardial recovery.
Objective: This study aimed to determine current cardioplegia practices in coronary artery bypass grafting surgery in Türkiye and variations according to the preferred cardioplegia type. Methods: A 16-item questionnaire was distributed to members of the Turkish Society of Cardiovascular Surgery involved in adult cardiac surgery between November 2023 and February 2024. The questions addressed cardioplegia type, temperature, dose, delivery method, redosing interval, topical cooling, and hot-shot use. Results: A total of 204 responses were analyzed. Blood cardioplegia was used by 69 (33.8%) participants, microplegia by 68 (33.3%), and Del Nido cardioplegia by 60 (29.4%). Most participants preferred a cardioplegia temperature of 4–10 °C (56.4%). Topical cardiac cooling was routinely used by 41.7%, and hot-shot administration by 47.1%. Antegrade cardioplegia alone was used by 59.3%, whereas 40.7% used combined antegrade and retrograde delivery. The roller pump was the most frequently preferred delivery technique (51.0%). The most common redosing interval was 15–20 minutes for blood cardioplegia (60.9%) and 60–90 minutes for Del Nido cardioplegia (71.7%). The most common blood-to-crystalloid ratios were 4:1 for blood cardioplegia (92.8%) and 1:4 for Del Nido cardioplegia (61.7%). Conclusion: Cardioplegia practices in adult coronary artery bypass surgery vary considerably in Türkiye. Blood-based cardioplegia remains the predominant strategy. Further studies should investigate the associations between cardioplegia practices, myocardial protection markers, and postoperative outcomes.
Objective: Corrected thrombolysis in myocardial infarction frame count (CTFC) is a quantitative angiographic method for assessing coronary flow after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Corrected QT interval (QTc) is associated with myocardial ischemia and adverse cardiovascular outcomes; however, its relationship with CTFC remains unclear. This study evaluated the relationship between QTc interval and CTFC in patients with STEMI undergoing primary PCI. Methods: This retrospective study included 133 STEMI patients who underwent successful primary PCI. Clinical, laboratory, electrocardiographic, and angiographic data were analyzed. QTc interval was calculated from admission electrocardiograms, and coronary flow was assessed by post-procedural CTFC. Correlations between CTFC and study variables were analyzed using Spearman correlation analysis. Results: The mean age was 56±12 years, and 80.5% were male. The mean QTc interval was 457.46±55.92 ms, and the mean CTFC value was 35.78±22.99. No significant relationship was observed between QTc interval and CTFC (r=-0.020; p=0.816). Among laboratory parameters, only neutrophil count showed a positive correlation with CTFC (r=0.177; p=0.042), whereas lymphocyte count showed a negative correlation with CTFC (r=-0.178; p=0.040). No significant relationship was found between CTFC and other clinical, laboratory, or procedural variables. Conclusion: This finding suggests that the QTc interval may not be a reliable indicator of post-procedural coronary flow as assessed by CTFC. However, the association of neutrophil and lymphocyte counts with CTFC supports the role of inflammation in coronary microvascular perfusion.
