Objective: Patients with Secondary Tricuspid Regurgitation (TR) scheduled for left-sided surgery were generally followed conservatively in previous periods, but tricuspid intervention has recently become increasingly common. In this study, we aimed to report the short-term results of tricuspid repair procedures performed in our tertiary university clinic. Materials and Methods: Data of 62 patients who underwent surgery for secondary TR at Balıkesir University Faculty of Medicine Hospital between August 2018 and May 2023 were retrospectively analyzed. Tricuspid repair procedures performed in patients with moderate to severe TR and tricuspid annulus diameter >40 mm who were scheduled for left-sided cardiac surgery were included in the study. Patients operated for primary TR, patients with active endocarditis, patients under 18 years of age, and patients with pregnancy status were excluded. Results: The mean age of the patients included in the study was 63.74 ± 10.2 years, 46 were female (74.2%) and 16 were male (25.8%). 48 patients underwent Tricuspid Ring Annuloplasty (TRA) and 14 patients underwent De Vega suture annuloplasty procedures. Preoperative creatinine value was higher in the De-Vega group (p=0.037). In the intervention according to TR calcification, 87.5% of the patients in the TRA group had severe TR, while this rate was 50% in the De-Vega group and a significant difference was found. (p=0.004) 30-day mortality was 12.9% in total and 10.4% in the Ring annuloplasty group and 21.4% in the De-Vega suture annuloplasty group, but there was no statistically significant difference (p=0.365). Conclusion: In this study, we planned to report the sort-term results of two repair methods of De-Vega and TRA for secondary TR. Key Words: Tricuspid Regurgitation, Ring annuloplasty, Suture annuloplasty

Abstract Background In this study, we aimed to evaluate the association of pan-immune-inflammation value (PIV) with major cardiovascular and cerebrovascular events (MACCE) in stable coronary artery disease patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods We retrospectively analyzed data from 527 patients who underwent on-pump CABG surgery for stable coronary artery disease between June 2015 and December 2020. Patients were categorized into two groups based on MACCE development. PIV levels were calculated from blood samples taken on admission. PIV was calculated as [neutrophil count (×103/µL)×platelet count (×103/µL))×monocyte count (×103/µL)]/lymphocyte count (×103/µL). The primary endpoint was long-term major cardiovascular and cerebrovascular events (MACCE) at a median follow-up of 4.6 years. Results Of the included patients, 103 (19.5%) developed MACCE. PIV was higher in patients with MACCE compared to those without (470.8 [295.3-606.8] vs. 269.8 [184.3-386.4], p < 0.001). Multivariate analysis showed a significant positive association between PIV and MACCE (HR: 1.326, 95%CI:1.212–1452, p < 0.001). The cut-off value for the PIV in the estimation of MACCE was 368.28 ( AUC: 0.726 with 69% sensitivity, 71% specificity, p < 0.001). Conclusion This study shows a significant link between high PIV levels and MACCE in stable coronary artery disease patients undergoing on-pump CABG surgery. Our findings suggest that PIV may be a valuable, routinely available, and inexpensive marker for identifying patients at increased risk of MACCE.

Background: This study aims to classify wound complications after median sternotomy and provide an up-to-date reconstructive algorithm for multidisciplinary use. Methods: A total of 15 patients (9 males, 6 females; mean age: 68±5 years; range, 60 to 75 years) who underwent sternal reconstruction for wound complications following median sternotomy between August 2020 and October 2023 were retrospectively analyzed. Wound complications requiring reconstruction were classified into three categories based on the extent of the dead space caused by sternal debridement. Type 1, 2, and 3 wounds presented with only skin defects and an intact sternum, with partial and total sternectomy, respectively. The time to consultation for plastic surgery and the duration of hospitalization were compared. Results: Among the wounds, type 2 wounds were the most common type seen in 11 patients. Two patients each had type 1 and type 3 wounds. A superior epigastric artery perforator skin flap was used for type 1 wounds. Bilateral pectoral and split pectoral turnover muscle flaps from the side where the internal mammary artery was intact were used for type 2 wounds. A rectus abdominis muscle flap was used for type 3 wounds. Early consultation from plastic surgery reduced the length of hospital stay. Conclusion: For type 1 wounds, skin flaps ensured sufficient coverage as they involved skin and subcutaneous fat, matching the defect. However, sternal excision required muscle flaps to fill the dead space, in which the vital organs were exposed.

OBJECTIVE:The aim of this study was to examine the relationship between caregiver burden, family adaptation, partnership, growth, affection, and resolve score, anxiety levels, and the perceived social support of the relatives of patients who had open heart surgery.METHODS:Volunteers among the relatives of patients who had open heart surgery in our cardiovascular surgery clinic and were followed up in the first 3 months were included in the study. The cardiovascular surgeons recorded the sociodemographic data of the relatives of the patients and directed them to a psychiatry clinic for further evaluation. The caregiver burden scale, family adaptation, partnership, growth, affection, and resolve scale, anxiety level scale, and perceived social support scale were applied to the relatives of the patients who participated in the study.RESULTS:Within the scope of the study, a total of 51 individuals, 29.4% (n=15) men and 70.6% (n=36) women, were included in the evaluation. The participants' ages ranged from 32 to 68 years, with an average age of 48 years. There was a statistically significant relationship between the caregiving burden scale score and the scale scores other than age (p<0.05). There was a statistically significant difference in terms of caregiving burden scale score, working status, physical and psychological problems, changes in home life, and changes in family relationships (p<0.05).CONCLUSION:The fact that the need for security and intimacy is related to anxiety and depression can be interpreted as the caregiving problems of the relatives of the patients who think that their patients are safe and feel closer to the intensive care personnel will decrease. Their depression and anxiety levels will also decrease.

IntroductionPreoperative nursing care affects many factors such as reducing the length of hospital stay of the patients in the perioperative period, the rate of postoperative complications, the duration of the operation, decrease of postoperative pain level and early mobilization.AimsWe aimed to determine the effect of preoperative evidence-based care education that given to cardiac surgery clinical nurses on the postoperative recovery of patients.MethodsThe research was planned as quasi-experimental. Eighty-six patients who underwent cardiovascular surgery were divided into control and intervention groups. First, the ongoing preoperative care practices and patient recovery outcomes of the clinic were recorded for the control group data. Second, education was provided for the clinical nurses about the preoperative evidence-based care list, and a pilot application was implemented. Finally, the evidence-based care list was applied by the nurses to the intervention group, and its effects on patient outcomes were evaluated. The data were collected using the preoperative evidence-based care list, descriptive information form, intraoperative information form and postoperative patient evaluation form.ResultsThe evidence-based care list was applied to the patients in the intervention group, with 100% adherence by the nurses. All pain level measurements in the intervention group were significantly lower in all measurements (p = .00). The body temperature measurements (two measurements) of the intervention group were higher (p = .00). The postoperative hospital stays of the control group and the intervention group were 11.21 +/- 8.41 and 9.50 +/- 3.61 days.ConclusionThe presented preoperative evidence-based care list can be used safely in nursing practices for patients. It provides effective normothermia, reduces the level of pain, shortens the hospital stay and reduces the number of postoperative complications.Relevance to Clinical PracticeBy applying a preoperative evidence-based care to patients undergoing cardiac surgery, pain levels, hospital stays and the number of complications decrease, and it is possible to maintain normothermia. An evidence-based care can be used to ensure rapid postoperative recovery for patients undergoing cardiac surgery.

Backgrounds: A combination of social inhibition and negative affectivity characterizes Type D personality. Type D, or distressed personality, is an established risk factor for the development and prognosis of coronary heart disease. It occurs in approximately 1 in 4 patients with coronary heart disease. This study aimed to investigate the relationship between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery. Methods: This retrospective and cross-sectional study was conducted in a university hospital psychiatry and cardiovascular surgery clinics between February 2022 and April 2022. Seventy-one volunteered patients over the age of 18 who underwent open-heart surgery in the cardiovascular surgery clinic were included in the study. Cardiovascular surgeons recorded the sociodemographic and clinical data of the patients and referred them to the psychiatry clinic for further evaluation. Subsequently, patients underwent psychiatric evaluation and were assessed using the Type D Personality Scale, Coping Attitudes Assessment Scale, Hospital Anxiety and Depression Scale, and Illness Perception Questionnaire. Results: According to this study, individuals with Type D personality tended to have higher scores on the Hospital Anxiety and Depression Scale. Analysis of the subdimensions of the Stress Coping Styles Scale revealed that individuals with Type D personalities showed a significantly lower optimistic approach and a considerably higher helpless approach. In terms of the subdimensions of the Illness Perception Questionnaire, it was found that individuals with Type D personality had a statistically lower treatment control approach and a statistically higher emotional representations approach. Conclusions: Identifying Type D personality traits in patients undergoing open-heart surgery can help manage negative illness perceptions through effective coping mechanisms.

Objective: This study aims to investigate the expression of Nesfatin-1, Galectin-3, Ghrelin, and Leptin in mediastinal adipose tissue and their relationship with postoperative complications in patients with and without metabolic syndrome who underwent on-pump coronary artery bypass graft (CABG) surgery.Method: Fifty patients who underwent CABG surgery and who were in sinus rhythm were included in the study.The patients were divided into two groups according to whether they had metabolic syndrome or not.All patients' age, gender, weight, height, postoperative intensive care unit length of stay, total hospital stay, and post-operative complications (Low cardiac output synd.Inotropy-IABP requirement, insulin-dependent diabetes mellitus, arrhythmia, kidney failure, respiratory failure) were recorded.In the histopathological evaluation, the expression density of Nesfatin-1, Galectin-3, Ghrelin, and Leptin in the the adipose tissue samples were mainly examined.Results: There was no statistically significant difference between the expression of Galectin-3, Ghrelin, and Leptin with post-operative complications, length of stay in the intensive care unit, and body mass index in patients with and without metabolic syndrome.However, there is a significant difference between Nesfatin-1 expression and the risk of Amaç: Bu çalışmanın amacı, on-pump koroner arter bypass grefti (CABG) ameliyatı yapılan metabolik sendromu olan ve olmayan hastalarda mediastinal yağ dokusunda Nesfatin-1, Galectin-3, Ghrelin ve Leptin ekspresyonlarını ve postoperatif komplikasyonlarla ilişkisini araştırmaktır.Yöntem: Çalışmaya CABG cerrahisi uygulanan ve sinüs ritminde olan 50 hasta dahil edilmiştir.Hastalar metabolik sendromu olanlar ve olmayanlar olarak iki gruba ayrıldı.Tüm hastaların yaşı, cinsiyeti, kilosu, boyu, postoperatif yoğun bakım yatış süreleri, total hastane yatış süreleri ve post-operatif komplikasyonlar (düşük debi send.İnotropi-IABP ihtiyacı, insüline bağımlı diabetes mellitus, aritmi, böbrek yetmezliği, solunum yetmezliği) kayıt altına

Abstract We aimed to investigate the ability of the C-reactive protein-to-albumin ratio (CAR) to predict ascending aorta progression in patients with 40–50 mm diameter of ascending aortic dilatation. A total of 182 diagnosed patients with ascending aortic diameters of 40–50 mm were enrolled in this study. The study population was divided into tertiles based on yearly ascending aortic growth rate values. Group I (n = 137) was defined as a value in the lower 2 tertiles (ascending aorta growth ≤ 1.00 mm/year), and group II (n = 45) was defined as a value in the third tertile (ascending aorta growth > 1.00 mm/year). Hypertension, chronic obstructive pulmonary disease, positive family history, and CAR were found to be independent risk factors for ascending aorta growth > 1.00 mm/year. The area under the ROC curve (AUC) of CAR was 0.771(95% CI 0.689–0.854) for predicting ascending aorta growth > 1.00 mm/year. In patients with 40–50 mm ascending aneurysms, CAR may be useful to predict ascending aorta progression.

OBJECTIVES:The aim of the study is to evaluate the predictive value of the model for end-stage liver disease (MELD) score for mortality in stable angina pectoris patients undergoing coronary artery bypass graft (CABG) surgery.METHODS:We retrospectively analyzed 261 consecutive patients with stable angina pectoris who underwent CABG while not being on anticoagulant therapy. The patients were divided into two groups: survivors and non-survivors. The MELD score was calculated for all patients. The all-cause mortality within postoperative 12 months was the primary end point of the study.RESULTS:The follow-up period was 12 months. The non-survivors were older (72.0±6.1 vs 62.4±8.4, p<0.001). The MELD score was significantly higher in the non-survivors group (7.5±1.2 vs 6.7±0.7, p<0.001). The MELD score (p=0.001) was an independent predictor of postoperative one-year mortality. The addition of MELD score to EuroSCORE II significantly improved the prognostic performance of the EuroSCORE II (EuroSCORE II vs EuroSCORE II plus MELD score: AUCs: 0.792 vs 0.842).CONCLUSION:Our research showed that the MELD score could be useful to predict mortality in patients who have stable coronary artery disease, and are undergoing CABG surgery (Tab. 3, Fig. 2, Ref. 25).

Background: Ascending aortic aneurysms are one of the primary causes of mortality. However, not much is known about the etiologies of aortic aneurysm. Recently, in hypertensive (HT) patients, blood pressure variability (BPV) has been recommended as a remarkable risk factor for adverse cardiovascular outcomes. This study aimed to explore the association between short-term BPV and ascending aortic dilatation (AAD). Methods: In this study, a total of 53 HT patients with AAD (aortic size index [ASI] ≥21 mm/m2) and 126 HT patients with a normal ascending aortic diameter (ASI <21 mm/m2) were included. Baseline, echocardiographic, and 24-h ambulatory blood pressure (BP) monitoring results were compared between groups. Standard deviation (SD) and coefficient of variation (CV) of BP were used to determine short-term BPV. Results: Except for daytime SBP values, daytime, nighttime, and 24-h mean systolic (SBP) and diastolic (DBP) BP levels were similar between groups. Compared with the HT patients with normal AA, daytime SBP, daytime SD of SBP, 24-h SD of SBP, daytime CV of SBP, and 24-h CV of SBP were significantly higher in HT patients with AAD. Compared with the HT patients with normal AA, the frequency of nondipper pattern was higher and dipper pattern was lower in HT patients with AAD. In multivariate logistic regression analysis, the daytime CV of SBP, daytime SD of SBP, 24-h SD of SBP, daytime SBP, and left ventricular mass index were independently associated with AAD. In receiver operating characteristic curve analysis, the daytime CV of SBP levels of >12.95 had a sensitivity of 61% and a specificity of 59% (area under the curve, 0.659; 95% CI, 0.562–0.756; P= .01); moreover, daytime SD of SBP > 16.4 had sensitivity of 62% and specificity of 61% (AUC, 0.687; 95% CI, 0.591–0.782; P< .001). :Conclusion Increased short-term BPV is independently associated with AAD and may be recommended as a remarkable factor risk for AAD in HT patients.

Blue toe sendromu; mikrovasküler oklüzyona bağlı bir veya daha fazla ayak parmağında veya ayak tabanında ağrı ve siyanoz ile karakterize klinik durumdur. En sık nedeni ateroembolik hastalıklar veya anevrizmadır. Embolizasyon genellikle aorto-iliak, femoral arterlerde bulunan ülsere aterosklerotik plaktan veya anevrizmadan meydana gelir. Blue toe sendromu gelişen bir hastada emboli kaynağını tespit ve tedavi etmek, uzuv kaybı ve/veya ölüm ile sonuçlanabilecek tekrarlayan embolileri önlemek adına oldukça önemlidir. Bununla birlikte yukarıda belirtilen klinik semptomlarla başvuran hastada yapılan ilk fizik muayenede periferik nabızların palpabl olması klinisyenleri vasküler patolojilerden uzaklaştırmakta, buna bağlı tanı koymada gecikme söz konusu olabilmektedir. Bu hastalarda mikrovasküler oklüzyondan şüphelenilmesi ve damar içi patolojileri teşhis için görüntüleme yöntemlerine başvurulması hayati önem arz etmektedir.

Central MessageOverlapping surgery has been a mainstay of complex cardiac repair since the legendary era of DeBakey, Cooley, and Crawford; suggestions that this practice increases risk may be much ado about nothing.See Article page 155. Overlapping surgery has been a mainstay of complex cardiac repair since the legendary era of DeBakey, Cooley, and Crawford; suggestions that this practice increases risk may be much ado about nothing. See Article page 155. Overlapping surgery is a relatively new term for physicians, patients, and health policy agencies to describe a longstanding practice that has been fairly common in cardiothoracic surgery: the practice of running 2 operative rooms. In 2015, this concept gained wide attention after an exposé was published by the Boston Globe Spotlight Team regarding potential risks and lack of patient awareness of the practice1Abelson J, Saltzman J, Kowalczyk L, Allen S. Clash in the name of care. Boston Globe. October 25, 2015. Available at: https://apps.bostonglobe.com/spotlight/clash-in-the-name-of-care/story/. Accessed December 16, 2019.Google Scholar; soon thereafter, publications regarding overlapping surgery followed from orthopedic and other surgeons, some focusing on its controversy and ethics.2Levin P.E. Moon D. Payne D.E. Overlapping and concurrent surgery: a professional and ethical analysis.J Bone Joint Surg Am. 2017; 99: 2045-2050Crossref PubMed Scopus (15) Google Scholar, 3Mello M.M. Livingston E.H. The evolving story of overlapping surgery.JAMA. 2017; 318: 233-234Crossref PubMed Scopus (26) Google Scholar, 4Zhang A.L. Sing D.C. Dang D.Y. Ma C.B. Black D. Vail T.P. et al.Overlapping surgery in the ambulatory orthopaedic setting.J Bone Joint Surg Am. 2016; 98: 1859-1867Crossref PubMed Scopus (46) Google Scholar, 5Zygourakis C.C. Sizdahkhani S. Keefe M. Lee J. Chou D. Mummaneni P.V. et al.Comparison of patient outcomes and cost of overlapping versus nonoverlapping spine surgery.World Neurosurg. 2017; 100: 658-664.e8Crossref PubMed Scopus (30) Google Scholar Overlapping surgery is described as the practice of the primary responsible surgeon participating in another operation after critical portions of the first operation are completed; typically, this is done with the understanding that there is no need for the primary responsible surgeon to return to the first operation. Usually, the primary responsible surgeon is defined as the surgeon who performs all critical parts of the procedure and is always available to return the operating room if needed. Although there is no formal definition of the “critical” components of a procedure, these are generally considered to be those portions of the operation that require the surgeon's specific expertise. The American College of Surgeons has indicated that overlapping surgery is an acceptable approach to managing operative repair as long as patients are informed of the practice. In contrast, concurrent surgery (participating in 2 or more surgical procedures in which some or all critical portions are performed simultaneously) is deemed an inappropriate practice by the American College of Surgeons. A recent meta-analysis of 14 studies of overlapping surgery (including neurologic, thoracic, cardiac, hip, knee, and other operations) found no association with increased risk of early mortality or morbidity.6Gartland R.M. Alves K. Brasil N.C. Mossanen M. Mort E. Wright C.D. et al.Does overlapping surgery result in worse surgical outcomes? A systematic review and meta-analysis.Am J Surg. 2019; 218: 181-191Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar Generally, overlapping surgery is framed within the context of elective repair. Potential benefits of overlapping surgery include the better use of operating room resources, facilitating greater volumes of complex surgery, reducing waiting time for specialty repairs, and a reduction of costs associated with academic medical institutions. In addition, overlapping surgery provides crucial learning opportunities for surgical residents during their training. However, a recent high-profile study analyzed the effects of overlapping in 8 different surgical procedures; an adjusted analysis showed that overlapping increased operative risk for coronary artery bypass grafting but not for the other 7 procedures (all noncardiac).7Sun E. Mello M.M. Rishel C.A. Vaughn M.T. Kheterpal S. Saager L. et al.Association of overlapping surgery with perioperative outcomes.JAMA. 2019; 321: 762-772Crossref PubMed Scopus (32) Google Scholar This finding raised concern that although overlapping surgery may be harmless in most specialties, perhaps cardiac surgery is negatively affected by this practice. In this issue of the Journal, Glauser and colleagues8Glauser G. Goodrich S. McClintock S.D. Szeto W.Y. Atluri P. Acker M.A. et al.Association of overlapping cardiac surgery with short-term patient outcomes.J Thorac Cardiovasc Surg. 2021; 162: 155-164.e2Abstract Full Text Full Text PDF Scopus (1) Google Scholar have focused on the safety of overlapping in cardiac surgery (which they defined as including open and endovascular procedures as part of cardiac or aortic repair); in addition, they assessed the effect of the timing of overlap. The authors used a robust matching approach (coarsened exact matching) to mitigate the individual risk profile of patients, resulting in 984 matched pairs of patients with and without surgical overlap. The results showed that overlapping cardiac surgery was no different from nonoverlapping surgery with regard to early mortality and morbidity, as well as short-term readmission and the need for reoperation. This study also indicated that the timing of the overlap (beginning or end of the procedure) had no effect on the outcomes studied. The authors fill a gap in that the impact of overlap has not been thoroughly investigated in cardiac surgery. Few patient-matched studies of overlap have been published—not only in cardiac surgery but in any type of surgery. The mastery of complex surgery depends on an active mentorship that can expose trainees to many cases within the relatively short window of supervised surgical training. Overlapping surgery has been a mainstay of complex cardiac operations since the legendary era of DeBakey, Cooley, and Crawford; suggestions that this practice increases operative risk may be much ado about nothing. Association of overlapping cardiac surgery with short-term patient outcomesThe Journal of Thoracic and Cardiovascular SurgeryVol. 162Issue 1PreviewThis study seeks to assess the safety of overlap in cardiac surgery. Full-Text PDF

We read with great interest the article by Hernandez and colleagues.1Hernandez JA, Stranix JT, Piwnica-Worms W, et al. Omental flap coverage for management of thoracic aortic graft infection. Ann Thorac Surg. 2020;109:1845–1849.Google Scholar It is well known that aortic graft infections can have catastrophic consequences with a high operative mortality rate, and there is no universal consensus regarding the appropriate management of thoracic aortic graft infection.2Bianco V. Kilic A. Gleason T.G. et al.Management of thoracic aortic graft infections.J Card Surg. 2018; 33: 658-665Crossref PubMed Scopus (16) Google Scholar The use of an omental flap for treatment of thoracic aortic graft infection has been previously reported in a couple of studies, but data are limited for this topic.3Tossios P. Karatzopoulos A. Tsagakis K. et al.Treatment of infected thoracic aortic prosthetic grafts with the in situ preservation strategy: a review of its history, surgical technique, and results.Heart Lung Circ. 2014; 23: 24-31Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar The article raises some important points regarding this study. The right and left gastroepiploic arteries provide the sole blood supply to the greater omentum, and both are branches of the celiac trunk. Blood flow in the celiac artery can be affected, especially in cases of aortic dissections and if there is any problem with celiac artery, such as stenosis, thrombosis, and dissection, the omental flap treatment can be failed. Omental flap in the context of vascularized lymph node transfer is an increasingly popular option for the treatment of lymphedema, and Cook and colleagues4Cook J.A. Sasor S.E. Tholpady S.S. Chu M.W. Omental vascularized lymph node flap: a radiographic analysis.J Reconstr Microsurg. 2018; 34: 472-477Crossref PubMed Scopus (5) Google Scholar excluded the dissection of the celiac artery. Thrombosis of the celiac artery and stenosis of the celiac artery were excluded to avoid possible flap failure.4Cook J.A. Sasor S.E. Tholpady S.S. Chu M.W. Omental vascularized lymph node flap: a radiographic analysis.J Reconstr Microsurg. 2018; 34: 472-477Crossref PubMed Scopus (5) Google Scholar Our second concern is that body mass index (BMI) greater than 35 kg/m2 is considered a contraindication factor for omental flap because of safety concerns expressed by some authors.5Shash H. Al-Halabi B. Aldekhayel S. Dionisopoulos T. Laparoscopic harvesting of omental flaps for breast reconstruction - a review of the literature and outcome analysis.Plast Surg (Oakv). 2018; 26: 126-133Crossref PubMed Scopus (5) Google Scholar However, the author did not mention the data regarding the celiac artery problems and BMI in the present study. We would like to emphasize that preexisting celiac artery problems and higher BMI scores could mask the outcomes, because these parameters can affect the omental flap coverage therapy. We think that it will be more reasonable if they have added the data of the aforementioned suggestions, which will intensify their study. Finally, we would like to conclude by congratulating Hernandez and colleagues1Hernandez JA, Stranix JT, Piwnica-Worms W, et al. Omental flap coverage for management of thoracic aortic graft infection. Ann Thorac Surg. 2020;109:1845–1849.Google Scholar on their outstanding study. Omental Flap Coverage for Management of Thoracic Aortic Graft InfectionThe Annals of Thoracic SurgeryVol. 109Issue 6PreviewSince the first reported use of prosthetic aortic grafts, infection has remained a feared complication. Pedicled omentum is the preferred flap in managing thoracic aortic graft infection (TAGI); however the literature is sparse. The authors present their experience with TAGI managed with pedicled omental flaps. Full-Text PDF Role of Celiac Trunk and Patient Body Mass Index on Omental Flap for Management of Thoracic Aortic Graft Infection: ReplyThe Annals of Thoracic SurgeryVol. 110Issue 3PreviewThank you for your interest in this work. We greatly appreciate the enthusiasm that this article has garnered since its publication.1 We agree that data are limited on this topic, and it was our goal to contribute to the body of literature on such a difficult surgical complication in an already-sick population. Full-Text PDF

ÖZ GİRİŞ ve AMAÇ: Kalp yetersizliği (KY) hastalarında sık karşılaşılan demir eksikliği (DE) ve demir eksikliği anemisi (DEA) artmış mortalite ve morbidite ile ilişkili

We read with great interest the article by Shantharam and colleagues.1Shantharam P.S. Joynt C. Al Aklabi M. Management of critical coarctation of aorta in a premature neonate with low birth weight.Ann Thorac Surg. 2020; 110: e225-e226Abstract Full Text Full Text PDF Scopus (4) Google Scholar It is well known that severe aortic coarctation in a newborn can have catastrophic consequences if not treated. There is a debate about the surgical approach in neonates. Treating only the isthmus may not be enough. Sakurai and colleagues2Sakurai T. Stickley J. Stumper O. et al.Repair of isolated aortic coarctation over two decades: impact of surgical approach and associated arch hypoplasia.Interact Cardiovasc Thorac Surg. 2012; 15: 865-870Crossref PubMed Scopus (28) Google Scholar published their 20-year experience with isolated aortic coarctation, and 54% of patients had an operation during the neonatal period. Their work shows that median sternotomy with aortic arch repair significantly reduces the risk of reintervention. Surgical indication for reintervention is associated with a degree of hypoplasia of the transverse arch.2Sakurai T. Stickley J. Stumper O. et al.Repair of isolated aortic coarctation over two decades: impact of surgical approach and associated arch hypoplasia.Interact Cardiovasc Thorac Surg. 2012; 15: 865-870Crossref PubMed Scopus (28) Google Scholar In addition, Gray and colleagues3Gray W.H. Wells W.J. Starnes V.A. Kumar S.R. Arch augmentation via median sternotomy for coarctation of aorta with proximal arch hypoplasia.Ann Thorac Surg. 2018; 106: 1214-1219Abstract Full Text Full Text PDF Scopus (14) Google Scholar showed that arch augmentation via median sternotomy is a safe and effective procedure. Furthermore, the majority of the patients who underwent surgery were receiving prostaglandin infusion; however, the authors did not mention the surgical approach of median sternotomy vs thoracotomy in premature neonatal patients. We would like to point out that isolated coarctation with transverse arch hypoplasia could be repaired through a median sternotomy, and this matter should be discussed with premature neonatal Z-scores. We think that it will be more reasonable if the authors have discussed these suggestions, which will intensify their case report. Finally, we would like to conclude by congratulating Shantharam and colleagues on their outstanding case report. Management of Critical Coarctation of Aorta in a Premature Neonate With Low Birth WeightThe Annals of Thoracic SurgeryVol. 110Issue 3PreviewPremature neonates with low birth weight have always posed a huge management dilemma, even for teams with great expertise. In this case report, we discuss a premature neonate born with extremely low birth weight diagnosed with critical coarctation of aorta and the challenges faced in stabilizing the neonate. As per our literature review, this is the smallest neonate, weighing only 680 g, to have undergone successful repair of coarctation of aorta through posterolateral thoracotomy. Identifying the ideal timing for surgery in premature neonates with low birth weight is most crucial to minimize morbidity and mortality. Full-Text PDF

Aim: Increased pulmonary artery pressure is associated with higher surgical risk in patients undergoing mitral valve replacement. The aim of this study was to investigate the effect of milrinone on the pulmonary artery pressures of patients with mitral valve disease (stenosis or regurgitation) who underwent mitral valve replacement surgery.

Background and Objectives: The aim of this study was to investigate the prognostic value of soluble ST2 (sST2) in predicting postoperative adverse events in patients with impaired left ventricular (LV) function undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: This study included 80 consecutive patients with stable coronary artery disease (CAD) and impaired LV function (ejection fraction ≤ 45%) undergoing on-pump coronary artery bypass graft surgery. The patients were divided into the “high” or “low” group according to their ST2 levels (≥35 or <35 ng/mL). Results: Postoperative adverse events were more common in patients with high sST2 levels than in patients with low sST2 levels (100% vs 26%, p < 0.0001). Multivariate analysis showed that sST2 level was an independent predictor of the presence of postoperative adverse events (OR: 1.117 (95% CI: 1.016–1.228), p = 0.022). The receiver operating characteristic curve (ROC) analysis of sST2 revealed an area under the curve (AUC) of 0.812 (95% CI: 0.710–0.913, p < 0.001) in predicting postoperative adverse events. An sST2 level of 26.50 ng/ml was identified as the optimal cut-off value, with a sensitivity and specificity of 74.1% and 75.3%, respectively. Conclusion: Higher sST2 levels were associated with adverse outcomes after CABG in patients with impaired LV and stable CAD.

We aimed to investigate the predictive value of the prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after elective coronary artery bypass grafting (CABG). A total of 336 consecutive patients with normal serum creatinine levels undergoing CABG were enrolled in this retrospective study. AKI was defined as meeting Acute Kidney Injury Network (AKIN) criteria based on the occurrence of creatinine changes within the first 48 h after CABG surgery. The patients were grouped according to whether they developed AKI or not into an AKI (−) and an AKI (+) group. AKI developed in 88 (26.2%) of all patients. The PNI was independently predictive of AKI (OR: 0.829, 95% CI: 0.783–0.877, p <  0.001). Moreover, C-reactive protein (CRP), a history of diabetes mellitus, and positive inotropric usage were independent risk factors for AKI in the multivariate logistic regression analysis. The area under the curve (AUC) of the multivariable model, including positive inotrope support, a history of diabetes mellitus, and CRP, was 0.693 (95% CI: 0.626–0.760, p <  0.001) in predicting AKIN. When the PNI was added to the multivariable model, the AUC was 0.819 (95% CI, 0.762–0.865, z = 3.777, difference p = 0.0002). Also, the addition of the PNI to the multivariable model was associated with a significant net reclassification improvement estimated at 88.2% (p <  0.001) and an integrated discrimination improvement of 0.22 (p <  0.001). Our study demonstrated that decreasing the PNI could be associated with the development of AKI after coronary artery bypass surgery.