Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB.Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5).Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0−T5 in all the functional microcirculatory parameters [%ΔTVDT0−T5(CCG): −10.86 ± 2.323 vs. %ΔTVDT0−T5(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0−T5(CCG): −12.91 ± 2.884 vs. %ΔPVDT0−T5(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0−T5(CCG): −2.345 ± 1.049 vs. %ΔPPVT0−T5(BCG): 1.482 ± 0.576, p < 0.01].Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.

Willingness to Respond (WTR) is the measurement of employees' preferences to come to work during off-hours when needed. Are these answers given before a disaster realistic? Another question of the study was, "Can we speed up the required staff to reach the hospital?" WTR survey has applied to emergency service staff. After that, the off-duty staff was called to work at a time they did not know beforehand. The study tried to identify how much WTR reflected the reality. Ninety of 98 (91.8%) participants whose surveys were evaluated answered "Yes" to "If you are called in case of disaster, would you come to duty?" question. When asked whether they will come to work according to disaster types, this rate was measured as 36.7% in "In the case of an infectious disease of which treatment is not clear". WTR surveys can be used to predict the level of participation of staff on off-hours in meeting the need for additional labor. These surveys' results can be expected to be similar to the labor participation rates in case of a real disaster and the arrival time of the staff at the hospital can be improved with new communication methods.

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Mert Dumantepe1*, Emre Salihlioğlu2, Murat Okten1, Nalan Karadag3, Alper Ozkan3, Yasemin Gundogdu4, Selim Isbir1 and Hasan Karabulut1 1Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey 2Department of Anesthesiology, Acibadem Altunizade Hospital, Istanbul, Turkey 3Department of Cardiology, Acibadem Altunizade Hospital, Istanbul, Turkey 4Department of Internal Medicine, Acibadem Altunizade Hospital, Istanbul, Turkey

Background The radial artery (RA) is the second most used conduit in coronary artery bypass surgeries. The increased harvest of RA demands new approaches towards the use of this conduit. We aim to compare the efficiency of electrocautery with the vessel sealing system LigaSure™. Materials and Methods This is a randomized trial comparing the use of LigaSure™ vessel sealing system and electrocautery in RA harvesting for coronary artery bypass surgery. Patients were randomly assigned into two groups. Group 1 consists of 27 patients operated with The LigaSure™ small jaw sealer/divider and Group 2 consists of 26 patients operated with electrocautery. Results During the study, 53 patients were operated. 44 of them were men and 9 of them were women. Difference between age and BMI were statistically insignificant. The amount of blood loss from the beginning of harvesting to the end of the closure of the skin of left arm was significantly less in group 1 (p=0,004). The difference in number of hemostatic clips before and after the anastomosis of radial artery to coronary artery are likewise statistically significant and less in group 1 (p<0,001; p<0,001 respectively). The amount of blood loss postoperatively (p>0,6), number of ecchymoses (p>0,1), hematoma (p>0,1) and infection postoperatively (p>0,03) are found to be statistically insignificant. Conclusion The LigaSure™vessel sealing system is found to be a better option of harvesting in patients that are prone to bleed.

Introduction: Post-thrombotic obstruction can be adequately treated by percutaneous transluminal angioplasty and stenting. When post-thrombotic trabeculations extend below the femoral confluence, proper inflow can be facilitated by endophlebectomy, patchplasty and creation of an arteriovenous fistula (AVF). The aim of this study was to investigate whether it is more favorable PTFE graft for the AVF at the endophlebectomy site to prevent early stenosis or occlusion. We carried out a prospective randomized study to compare the patency of standard grafts with heparin-bonded grafts. Methods: A temporary femoral AVF is created using a ring-reinforced 6 mm PTFE graft between June 2016 and January 2018. Patients were randomized to receive either a standard polytetrafluorethylene (PTFE) graft or a heparin-bonded ePTFE graft (Propatenâ, W. L. Gore & Associates). The fistula was given a loop-like shape to simplify later percutaneous plug occlusion. We analyzed the clinical data of all patients who underwent a hybrid procedure in our center. Demographics, interventional details and post-operative imaging were collected Results: In this study, 38 patients were randomized and followed up for 6 months. No patient was lost to follow-up. Primary patency was 45% (10/22) and 31% (7/22) for standard PTFE grafts and 100% (16/16) and 93.7% (15/16) for heparin-bonded Propaten at 3 and 6 months, respectively (P <0.001). There were significantly fewer thromboses in heparin-bonded grafts compared to standard PTFE during the first 6 months (P <0.001). Of 22 standard PTFE grafts, 15 were eventually occluded versus only 1 heparin-bonded ePTFE graft. Logistic regression showed that only reduced femoral inflow (hazard ratio 2.946 (95%CI, 1.148–7.494)) was a significant predictor of early iliac venous stent stenosis and/or occlusion. Furthermore, logistic regression for risk of occlusion showed a significant influence of graft-related complications (hazard ratio 4.377 (95%CI, 1.205–18.260)) and a tendency towards influence of arteriovenous fistula flow and patency in favor of the Heparin bounded Propaten. Bleeding complications, infections rates were similar in both groups. Conclusion: Placement of the temporary arteriovenous fistula of the endophlebectomy site during hybrid recanalization may result in a more favorable outcome. Heparin-bonded ePTFE grafts demonstrated a trend to improved patency, and the difference was statistically significant. Moreover, Propaten grafts had a significantly lower early thrombosis rate that was sustained for 6 months of follow-up for this extremely unique indication.

Introduction: Popliteal artery injury is a potentially-limb threatening complication of traumatic knee dislocation. The purpose of this study was to evaluate the feasibility and effectiveness of endovascular repair of traumatic popliteal a3.102rterial injuries.

Background: Chronic post-thrombotic occlusion of the iliofemoral veins causes significant morbidity, which can be alleviated if venous drainage is restored. We report our technique of surgical endophlebectomy and patchplasty of the common femoral vein (CFV) in conjunction with iliac vein stenting to restore venous flow from the infrainguinal venous system to the vena cava. Methods: There were 157 patients who underwent CFV endophlebectomy combined with iliocaval recanalization. Questionnaires were completed both preoperatively and postoperatively to allow comparison. These included the Clinical, Etiology, Anatomy, and Pathophysiology clinical classification; the Venous Clinical Severity Score; the Villalta scale; the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms; and the 36-Item Short Form Health Survey quality of life questionnaire. Results: Mean follow-up duration was 14.4 +/- 2.9 months (range, 10-29 months). The mean preoperative Venous Clinical Severity Score was 15.3 +/- 2.2, and this fell to 6.1 +/- 1.8 after treatment (P < .001). The mean preoperative Villalta score dropped from 12.7 +/- 2.6 to 6.3 +/- 1.4 (P < .001). The quality of life and symptom severity scores were improved after 3 months by 17.2 points for quality of life (P < .001) and 20.5 points for symptom severity (P < .001). Primary patency was 81% (124/153) and secondary patency was 89.5% (137/153) at 12 months. Wound complications related to groin incision and lymphatic fistulas were observed in 22.8% (35/153) and 28.7% (44/153), respectively. Conclusions: The hybrid operation of CFV endophlebectomy in conjunction with iliac vein recanalization should be considered a safe and effective treatment option in patients with severe post-thrombotic syndrome and iliofemoral veno-occlusive disease.

Background In this study, we present our clinical experience and midterm results with the robotic-assisted concomitant procedures during mitral valve operations. Methods Between March 2010 and February 2018, a total of 34 patients (8 males, 26 females; mean age 58.3 years; range, 34 to 78 years) who underwent robotic-assisted concomitant procedures during mitral valve surgery were retrospectively analyzed. Demographic characteristics of the patients, comorbidities, medical, and surgical histories, operative and laboratory results, electrocardiographic findings, postoperative intensive care unit and ward outcomes, and cardiac follow-up data were recorded. Atrial fibrillation-related medication use, stroke, or other thromboembolic events, and electrocardiographic reports in patients who underwent cryoablation were reviewed at three and 12 months after the operation. Results A total of 76 robotic-assisted concomitant procedures were performed during mitral valve repair (n=11) or replacement (n=23) in 34 patients. These procedures were cryoablation (n=29), tricuspid valve repair (n=6), tricuspid valve replacement (n=2), left atrial appendage ligation (n=32), atrial septal defect and patent foramen ovale closure (n=5), and left atrial thrombectomy (n=2). The mean preoperative EuroSCORE values were 5.1±2.5. The mean duration of cardiopulmonary bypass and cross-clamp was 156±69.4 min and 101±42 min, respectively. Normal sinus rhythm was restored in 85% of the patients (24/28) after cryoablation and two patients (5.8%) had permanent pacemaker within a year during follow-up. There was one (2.9%) mortality in the early postoperative period due to hemorrhage related to the posterior left ventricular wall rupture. No blood product was used in 82.4% of the patients. One patient had a transient cerebral event and symptoms regressed completely within two months. Conclusion Technological improvements and growing experience can decrease the suspects related to prolonged operational duration during robotic-assisted cardiac surgery. Concomitant procedures in addition to mitral valve operations can be performed with low complication rates in centers with experience of robotic surgery.

In this study we aimed to evaluate the effects of dilutional anemia resulting from cardiopulmonary bypass (CPB) and its correction with red blood cell (RBC) transfusion on tissue oxygenation and renal function in diabetic patients undergoing coronary artery bypass grafting (CABG).

Coronary artery disease and abdominal aortic aneurysm may frequently be together, particularly in elderly patients. Treatment strategies should be tailored according to the needs and specific properties of each patient. Hybrid synchronous procedures may be a choice of therapy in these patients, as well as staged procedures. Herein, we present the first hybrid synchronous case of Turkey to treat two separate cardiovascular pathologies.

Despite the increased risk for adverse outcomes, patients with chronic kidney disease (CKD) presenting with coronary artery disease are less likely to receive evidence-based therapies. Several studies demonstrated that anemia and blood transfusions are both risk factors for mortality, while others argue that it is preoperative anemia -rather than RBC transfusion itself- that is harmful. There is still a gap to adequately address this issue especially in patients with CKD.

BACKGROUND:The readmission in the early period (RAEP) is defined as the admission of a patient to emergency department (ED) for the second time within 72 hours after discharge from the ED.AIMS:The aim of this study was to determine the disease, patient, doctor, and system related causes of RAEP.STUDY DESIGN:Descriptive study.METHODS:This study is a two-stage study that was conducted at Department of Emergency, Gazi University Faculty of Medicine. The causes of RAEP were defined as disease, patient, doctor, and system related causes.RESULTS:A total of 46,800 adult patients admitted to ED during the study period and 779 (1.66%) patients required RAEP. After the exclusion criteria, 429 of these patients were included the study. The most common reasons for RAEP were renal colic in 46 (10.7%) patients. It was detected that 60.4% of the causes of RAEP were related to disease, 20.0% were related to the doctor, 12.1% were related to the patient, and 7.5% were related to the hospital management system.CONCLUSION:This study revealed that there are patient-, doctor-, and system-related preventable reasons for RAEP and the patients requiring RAEP constitute the high risk group.

BACKGROUND/AIM:The aim of the current study was to assess the accuracy of cardiac output (CO) measurements obtained by the Nexfin finger cuff method as compared with the FloTrac/Vigileo and echocardiography methods in coronary artery bypass grafting (CABG) patients.MATERIALS AND METHODS:First-time elective CABG patients were prospectively enrolled in this study and divided into three groups according to CO measurement method. CO measurements were performed simultaneously by three different contributors and were collected by the fourth one 24 h postoperative in the intensive care unit (ICU). Data were statistically analyzed.RESULTS:Seventeen female and 13 male patients between 42 and 78 years of age (with a mean of 56 ± 4) were the subjects of this study. The mean CO measurements were 5.9 ± 1.4 L/min, 5.8 ± 1.1 L/min, and 6.0 ± 1.1 L/min for the Nexfin, FloTrac/Vigileo, and echocardiography methods, respectively (P > 0.05). The correlation values between Nexfin and FloTrac/Vigileo, Nexfin and echocardiography, and FloTrac/Vigileo and echocardiography were r = 0.445, r = 0.377, and r = 0.384, respectively (P < 0.05).CONCLUSION:Nexfin yielded results comparable to those obtained with FloTrac/Vigileo and echocardiography for the postoperative CO assessment of CABG patients. Nexfin may be used in uncomplicated, hemodynamically stable patients in ICU as a reliable and totally noninvasive method of CO measurement.

Background: This study aims to analyze the possible correlation between the blood lactate levels and mixed venous oxygen saturation after coronary artery bypass grafting.Methods: The study included a total of 147 adult patients (104 males, 43 females; mean age 59 +/- 11 years; range 36 to 87 years) who underwent elective coronary artery bypass grafting with extracorporeal circulation between November 2011 and December 2012. Arterial blood gas, mixed venous gas, and hemodynamic variables were recorded at postoperative 30, 60, 120 and 240 min, and 24 hours. The patients were classified based on the use of inotropic agents: group 1 included 53 patients who received inotropic support and group 2 included 94 patients who did not. Both groups were assessed with respect to the correlation between the arterial lactate level and mixed venous oxygen saturation, and for other hemodynamic variables.Results: Early postoperative mortality did not occur. In group 1, a significant correlation was found between the arterial lactate level (1.6 +/- 0.1 mmol/L) and mixed venous oxygen saturation (7.4 +/- 0.0%) at 240 min postoperatively. In both groups and at any time points, the levels of arterial blood gas lactate and blood glucose consistently showed a significant correlation.Conclusion: Although blood lactate levels provide invaluable information on the adequacy of tissue perfusion, changes in lactate levels do not correlate with mixed venous oxygen saturation, addressing the need for evaluating hemodynamic changes together with lactate levels.

ÖZ Amaç: Bu çalışmada ekstrakorporeal dolaşım uygulanan elektif açık kalp cerrahisi hastalarında, mikro dolaşımın bozulma potansiyeli en fazla olan dönemin ve mikro dolaşım ile ilişkili olan diğer hemodinamik ve kan gazı parametrelerinin belirlenmesi amaçlandı. Ça­lış­ma­ pla­nı:­ İlk kez elektif açık kalp cerrahisi yapılması planlanan 20 erişkin hasta (12 erkek, 8 kadın; ort. yaş 56.4 yıl dağılım: 38-77 yıl) prospektif olarak çalışmaya alındı. Doku oksijen satürasyonu, kalp hızı, nabız oksimetresi, elektrokardiyografi, invaziv arteriyel kan basıncı monitörizasyonu, bispektral indeks ve serebral rejyonel oksijen satürasyonu monitörizasyonları yapıldı. Anestezi indüksiyon öncesi, ameliyat sırası ve ameliyat sonrası dönemlerde ölçümler tekrarlandı ve kaydedildi. Bul gu lar: Ameliyat sırası dönemde, hastaların en düşük doku oksijen satürasyonu değerleri ile sağ ve sol serebral rejyonel oksijen satürasyonu yüzde değişim değerleri ısınma döneminde tespit edilmiş olup, sırasıyla %69±2, –%17±2, –%14±2 idi. Ameliyat sonrası dönemde ise en düşük değerler ameliyat sonrası birinci saatte olup değerler sırasıyla %59±2, –%15±4, –%12±3 idi. Doku oksijen satürasyonu, laktat ve serebral rejyonel oksijen satürasyonu değerlerinde gözlenen düşüşler birbirleri ile anlamlı ilişki gösterdi (p<0.05). So­nuç:­ Hipotermi, hemodilüsyon ve nonpulsatil akımın olduğu ekstrakorporeal dolaşım sırasında ve sonrasında mikro dolaşım bozulabilmekte; ancak, bu standart izlem parametreleri ile zamanında tespit edilememektedir. Standart monitörizasyona ilave olarak doku oksijen satürasyonu takibi ile mikro dolaşımın değerlendirilmesinin sonuç parametreleri açısından anlamlı olacağı kanısındayız. Anah­tar­söz­cük­ler: Ekstrakorporeal dolaşım; mikro dolaşım; doku oksijen satürasyonu. ABSTRACT Background:­ In this study, we aimed to identify the potential period which microcirculation tends to mostly deteriorate and other hemodynamic and arterial blood gas parameters associated with microcirculation in patients undergoing elective open heart surgery with extracorporeal circulation. Methods: Twenty adult patients (12 males, 8 females; mean age 56.4 years; range 38 to 77 years) who were scheduled for elective first-time open heart surgery were prospectively included in the study. Tissue oxygen saturation heart rate, pulse oximetry, electrocardiography, invasive arterial blood pressure monitoring, bispectral index, and regional cerebral oxygen saturation monitoring were performed. Measurements were repeated and recorded before anesthesia induction, preoperatively, and postoperatively. Results:­ The lowest tissue oxygen saturation values and the highest % alteration of the right and left regional cerebral oxygen saturation were in the re-warming period perioperatively with 69±2%, –17±2%, –14±2%, respectively. The lowest values in postoperative period were measured at the postoperative first hour with 59±2%, –15±4%, –12±3%, respectively. Reductions in the tissue oxygen saturation, lactate and regional cerebral oxygen saturation values were statistically significantly correlated with each other (p<0.05). Conclusion:­ Hypotermia, hemodilution and nonpulsatile flow during and after extracorporeal circulation may deteriorate microcirculation; however, standard monitoring variables may fail to detect this deterioration timely. We believe that microcirculation evaluation with standard monitorization with the addition of tissue oxygen saturation monitorization may be of significance for the outcome variables.

Objective: The study was done to determine the effect of different types of drain to postoperative effusion and pain on patients who enderwent coronary artery bypass grafting (CABG).Material and Methods: 50 patients data were evaluated prospectively. Standart drain was placed into 7-8th intercostal area (Group 1). L drain was placed into pleural area (Group 2). Demographic data, drainage amounts were written from hospital documents. Postoperative phericardial and pleural effusion was determined by echocardiography and chest x-ray. Verbal Rating Scale was used to dedicate pain score. Data were analyzed by T test.Results: Groups demographic data were similar. Drainage was 652.0 +/- 328.3 ml (Group 1), 620.0 +/- 169.5 ml (p=0.04) in Group 2. Pain score before taking of drain was 2.0 +/- 2.6 (Group 1), 1.0 +/- 1.6 (p=0.01) in Group 2, after taking of drain was 4.7 +/- 3.0 (Group 1), 2.1 +/- 2.0 (p=0.05) in Group 2. Fifteen day mean phericardial effusion was 0.2 +/- 0.4 cm (Group 1), 0.1 +/- 0.3 (p=0.05) in Group 2. There was no difference between other parameters.Conclusion: Using both types of drain seems to be safe but L drain is more comfortable because of less pain.

Gebode defect, that can accurately be treated surgical repair, is defined as a true communication between left ventricle and right atrium. A 74-year-old woman with a worsening history of ortophnea and peripheral edema was hospitalised. A communication between right atrium and left ventricle was diagnosed using transeusophageal echocardiography. The defect was repaired and mitral valve was replaced with a biologic valve. It would be beter to tailor surgical strategy for each case with atrioventricular canal defect after preoperative transeusophageal echocardiography and peroperative direct sight.