RESUMEN

OBJECTIVES: Sarcopenia has been demonstrated to be related to unfavorable clinical outcomes in patients with vascular diseases. The purpose of this study is to evaluate the relationship between sarcopenia and clinical results in patients with peripheral arterial disease who underwent endovascular therapy (EVT). METHODS: This single-center retrospective study involved patients with PAD who underwent peripheral EVT at Ankara City Hospital, between January 2018 and December 2021. Two groups of patients were created: sarcopenic and non-sarcopenic patients according to computed tomography angiography muscle measurements. Primary outcome measures were major and minor amputation and survival. Mortality, amputation, and clinical characteristics were compared between the two patient groups. Hazard ratios (HRs) for amputation were calculated for each risk factor via univariate and multivariate analyses. Secondary outcomes included length of hospital stay and post-procedural complications. RESULTS: The mean follow-up period was 29.9 ± 9 months for all patients. A total number of 100 patients (mean age 63.5 ± 9.2 years) were involved in the study cohort. A significant association was identified between mortality and sarcopenia (p < .001). The mortality rate in the group with sarcopenia was significantly higher than the other group; 65.7% (23 patients) versus (20%, 13 patients) (p < .001). The major amputation rate in the group with sarcopenia was 57.1%, the major amputation rate in the group without sarcopenia was calculated as 15.4%, revealing that the major amputation rate was detected to be significantly higher in the sarcopenia group (p < .001). Multivariate regression analyses showed that only sarcopenia (HR, 0.52; 95% CI, 0.21-1.27; p = 0.15) was independently associated with major amputation in patients with PAD after EVT. Kaplan-Meier analysis revealed a statistically significant difference between the survival curves of sarcopenia and non-sarcopenia patients (p < .001). CONCLUSIONS: Sarcopenia seems to be a possible risk factor associated with amputation in patients with PAD who undergo EVT. The results of this study imply that sarcopenia is a possible risk factor for overall survival in patients with PAD.

RESUMEN

Objectives: Secondary hyperparathyroidism (sHPT) is a prevalent complication of end stage renal disease in which serious morbid conditions and mortality can be encountered. Although the best solution of this severe problem is renal transplantation, because of the huge demand and limited resources, this cannot be possible most of the time. Initial treatment alternative is medical treatment in patients with sHPT and parathyroidectomy (PTX) should be applied if does not help. Subtotal PTX, total PTX and total PTX together with autotransplantation are the current surgical options preferred for sHPT. Intraoperative parathyroid hormone (IO PTH) monitoring can increase surgical success in sHPT. We aimed to determine the ideal surgical technique and relation of IO PTH monitoring with surgical success in patients with sHPT through our study. Methods: We analyzed all the data of the 35 patients who had PTX and follow up between January 2001 and December 2021 because of sHPT at General Surgery Department of Akdeniz University Medical Faculty Hospital in retrospective manner. Results: Twenty-seven of the patients had been applied subtotal PTX while six of the cases had experienced limited surgery and two of them had undergone total PTX. Persistance happened to be present in the follow-up of nine patients and recurrence in one of them. Four persistant and one recurrent cases were present in 23 patients with IO PTH monitoring (78.3% surgical success), while there were persistences in each of the three patients with no IO PTH monitoring (0% success of surgery) (p=0.022). IO PTH monitoring data of nine patients could not be reached. In this study, 20 patients had IO PTH decline of 80% or more (90% surgical success) and three patients had IO PTH decline below 80% (0% surgical success) (p=0.006). Subtotal PTX was applied to 17 (94.1% surgical success) of these 20 patients. Conclusion: In surgical treatment of patients with sHPT, IO PTH monitoring should be maintained and operation should not be finished until 80% or more decline in IO PTH level had been detected. Among the surgical alternatives for sHPT, subtotal PTX appears as an effective and valid method when performed together with IO PTH monitoring, provided that there is a decline in PTH level of 80% or more.

RESUMEN

BACKGROUND: Behcet's disease (BD), originally described by Hulusi Behcet in 1937, is a chronic relapsing inflammatory process of an immunologic syndrome and the involvement of the vascular system is called Vasculo-Behcet disease (VBD). This is a retrospective study evaluating 21 patients diagnosed with VBD who underwent endovascular treatment. METHODS: This single-center study was conducted between January 2016 and January 2022. Early and mid-term endovascular outcomes of a total of 21 patients (16 males, 5 females with a median age of 42 years; range, 31 to 46 years), with a diagnosis of VBD, who underwent endovascular arterial repair in our hospital, were retrospectively analyzed. Follow-ups were scheduled for the first and sixth postoperative months and every 6 months thereafter. For symptomatic patients, imaging studies and additional interventions were planned. The primary outcomes were a procedural success and a requirement for reintervention. Secondary outcomes were complications and all causes of mortality. RESULTS: Twenty-one patients underwent endovascular repair. In this study, 1 balloon-expandable stent for brachial artery aneurysm (4,8%), 1 viabahn graft for femoral artery aneurysm (4,8%), 2 tube endograft for ruptured iliac artery aneurysm (9,5%), 1 tube endograft (Thoracic endovascular aortic repair [TEVAR]) insertion at the aortic bifurcation for infrarenal abdominal aortic occlusion (4,8%), 1 chimney-TEVAR for saccular arcus thoracic aortic aneurysm (TAA) (4,8%) and 7 TEVAR for saccular TAA (33,3%), 1 EVAR for an intact and symptomatic infrarenal abdominal aortic aneurysm (AAA) (4,8%), 1 EVAR (aorto-uniiliac) for ruptured iliac artery aneurysm (4,8%), and 6 EVAR for ruptured AAA (28,5%) were deployed. The technical success rate was 100% with a mean follow-up period of 50. 4 ± 10.7 months (8-66 months). The mean aneurysm diameter was 10,7 ± 53 mm. In the follow-up period, 3 patients presented with a hematoma at the insertion site of the sheath (14.3%). There were no early mortalities. Three patients required reintervention (14,3%); 1 of these underwent open surgical repair due to a pseudoaneurysm of the access site (4,8%). The Kaplan-Meier analysis revealed freedom from reintervention rate as 94,1 ± 5,7% at 1 year, 85,6 ± 9,7% at 3 years, and 68,4 ± 17,1% at 5 years. CONCLUSIONS: Awareness of the BD especially for vascular involvements in young ages is lifesaving. Endovascular therapy with proper medical treatment seems to be the treatment of choice according to the early and midterm successful results with low morbidity and mortality.

Asunto(s)

RESUMEN

Horseshoe kidney (HSK) is one of the most common congenital renal fusion anomalies. Difficulties are encountered during surgery of aortic diseases associated with this anomaly. A 47-year male presented to the Outpatient Clinic with one-year history of intermittent claudication in 20 meters. He was diagnosed with Leriche syndrome and horseshoe kidney (HSK). The patient underwent aorto-bifemoral bypass surgery via transperitoneal approach. The proximal anastomosis was completed in an end-to-side fashion. The bifurcated graft was positioned posteriorly to the isthmus; and distal anastomoses were performed onto the common femoral arteries. He was discharged from the hospital on the eighth postoperative day without any complications. Key Words: Abdominal aorta, Surgery, Horseshoe kidney, Leriche syndrome.

Asunto(s)

RESUMEN

BACKGROUND: To evaluate the value of Glasgow Aneurysm Score (GAS) in predicting long-term mortality and survival in patients who have undergone endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). METHODS: A retrospective single-center study of 257 patients with non-ruptured AAA undergoing EVAR between January 2013 and 2021. GAS scores were compared between the survivors (group 1) and the long-term mortality (group 2) groups. Cox regression analysis was used to determine independent predictors of late mortality. Receiver operating characteristic curve (ROC) analysis was used to determine the optimum cut-off values of GAS values to determine the effect on late-mortality. Survival analysis was conducted using Kaplan-Meier. RESULTS: The study included 257 patients with a mean age of 69.75 ± 7.75 (46-92), who underwent EVAR due to AAA. Average follow up period was 18.98 ± 22.84 months (0-88). Fourty-five (17.8%) mortalities occured during long-term follow-up. A past medical history of cancer resulted in a 2.5 fold increase in risk of long-term mortality (OR: 2.52, 95% CI 1.10-5.76; p = 0.029). GAS values were higher in group 2 compared to group 1 (81.02 ± 10.33 vs. 73.73 ± 10.46; p < 0.001). The area under the ROC curve for GAS was 0.682 and the GAS cut-off value was 77.5 (specificity 64%, p < 0.001). The mortality rates in patients with GAS < 77.5 and GAS > 77.5 were: 12.8% and 24.8% respectively (p = 0.014). Every 10 point increase in GAS resulted in approximately a 2 fold increase in risk of long-term mortality (OR: 1.8, 95% CI 1.3-2.5; p < 0.001). Five year survival rates in patients with GAS < 77.5 and > 77.5 were 75.7% and 61.7%, respectively (p = 0.013). CONCLUSIONS: The findings of our study suggests that an increase in GAS score may predict long-term mortality. In addition, the mortality rates in patients above the GAS cut-off value almost doubled compared to those below. Furthermore, the presence of a past history of cancer resulted in a 2.5 fold increase in long-term mortality risk. Addition of cancer to the GAS scoring system may be considered in future studies. Further studies are necessary to consolidate these findings.

Asunto(s)

RESUMEN

OBJECTIVE: To determine the efficacy of a sternal wire system in secondary sternal dehiscence after repeat closure of the sternum, following surgical revision after open heart surgery. STUDY DESIGN: Case-control study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Zonguldak Bülent Ecevit University, Zonguldak, Turkey; and Turkey Yuksek Ihtisas Training and Research Hospital, Turkey, from January 2015 to May 2019. METHODOLOGY: Patients, who underwent open heart surgery with median sternotomy, were included in this retrospective study. The patients were divided into two groups, according to the sternal closure material. The time of the sternal reconstruction surgery, because of sternal dehiscence, fracture, broken sternal wire(s) or cable(s) after the first revision surgery, was noted for each patient. RESULTS: A total of 389 patients were identified. Group 1 included 72 (50%) patients whose sternums were closed with a sternal cable system; and Group 2 included 72 (50%) patients whose sternums were closed with conventional steel wires after propensity matching. The duration of cardiopulmonary bypass, number of intra-aortic balloon pumps used, and number of extracorporeal membrane oxygenators used were significantly higher in Group 1 (p = 0.007, p = 0.034, and p = 0.028, respectively). The number of emergency operations was significantly higher in Group 2 (p = 0.021). There was no significant difference in terms of secondary sternal dehiscence between the groups (p = 0.366). CONCLUSION: Application of the sternal wire system in revisional open heart surgery is not more effective than conventional steel wire at preventing secondary sternal dehiscence. Key Words: Sternal dehiscence, Sternal cable, Sternal wire, Open heart surgery, Postoperative revision.

Asunto(s)

RESUMEN

Injury of the lymphatic trunk during abdominal aortic surgery causes leakage of chyle into the peritoneum, resulting in chylous ascites. A 53-year male, who underwent aortobifemoral bypass surgery for Leriche syndrome in our clinic, presented to the Emergency Department two months postoperatively, with complaints of abdominal discomfort, reduced appetite and weight loss. Computed tomography imaging and ultrasound of the abdomen revealed a retroperitoneal fluid collection. The patient was admitted and treated with percutaneous drainage of the chylous ascites, total parenteral nutrition (TPN) of a low fatty diet containing medium-chain triglycerides (MCT), and intravenous antibiotics. He was discharged after three weeks of treatment. This case report is an example of a rare complication that may occur after abdominal aortic surgery; and enables us to review treatment options for the management of chylous ascites. Key Words: Chyle,  Ascites, Abdominal aortic surgery.

Asunto(s)

RESUMEN

Abstract Introduction: Valve-reimplantation and remodelling techniques used in aortic reconstruction provide successful early, mid, and long-term results. We present our early and late-term experience with 110 patients with aortic regurgitation (AR) who underwent aortic valve repair (AVr) or valve-sparing aortic root surgeries (VSARS) due to aortic dissection or aortic aneurysm. Methods: Nine hundred eighty-two patients who underwent aneurysm or dissection surgery and aortic valve surgery between April 1997 and January 2017 were analysed using the patient database. A total of 110 patients with AR who underwent AVr or VSARS due to aortic dissection or aortic aneurysm were included in the study. Results: In the postoperative period, a decrease was observed in AR compared to the preoperative period (P<0.001); there was an increase in postoperative ejection fraction (EF) compared to the preoperative values (P<0.005) and a significant decrease in postoperative left ventricle diameters compared to the preoperative values (P<0.001). Kaplan-Meier analysis revealed one, two, four, and five-year freedom from moderate-severe AR as 95%, 91%, 87%, and 70%, respectively. Freedom from reoperation in one, two, and five years were 97.9%, 93.6%, and 81%, respectively. Eight patients (7.4%) underwent AVr during follow-up. Out of the remaining 100 patients, 13 (12%) had minimum AR, 52 (48%) had 1st-2nd degree AR, and 35 (32%) had 2nd-3rd degree AR during follow-up. Conclusion: For the purpose of maintaining the native valve tissue, preserving the EF and the left ventricular end-diastolic diameter, valve-sparing surgeries should be preferred for appropriate patients.

Asunto(s)

RESUMEN

BACKGROUND: We present early and mid-term clinical outcomes of endovascular revascularization for femoropopliteal involvement of peripheral arterial disease. METHODS: A total of 128 patients (113 males, 15 females; mean age: 63.4±9.9 years; range, 32 to 87 years) who underwent percutaneous transluminal angioplasty for femoropopliteal lesions between August 2016 and April 2018 were analyzed retrospectively. Treatment with Luminor® paclitaxel-coated drug-eluting balloon catheter or bailout therapy with iVolution® self-expanding nitinol stent were performed. Overall patency rates and freedom from reintervention rates were analyzed using the Kaplan-Meier analysis. The primary patency and freedom from reintervention to target lesion rates at 12 and 24 months were evaluated. RESULTS: Technical success was achieved in 133 (93%) of the interventions with a median follow-up of 11 (range, 1 to 35) months. At 12 and 24 months, the mean overall patency rates were 85.6±3.7% and 66.8±6.7%, respectively and the mean freedom from reintervention to target lesion rates were 91.6±2.9% and 78.1±6.3%, respectively. The primary patency and freedom from reintervention to target lesion rates were significantly higher in the bailout stenting group than the drug-eluting balloon group at 12 months (97.3±2.7% vs. 94.8±6.1%, respectively, p=0.025 and 97.1±2.9% vs. 84.2±5.5%, respectively, p=0.005) and at 24 months (76.9±7.9% vs. 55.8±13.4%, respectively, p=0.025 and 85.2±7.0% vs. 70.2±13.6%, respectively, p=0.005). CONCLUSION: Endovascular procedures including drug-eluting balloon and bailout stenting seem to be effective alternative treatment modalities for treatment of infrainguinal peripheral arterial disease and can be also used in patients with long lesions and/or total occlusion of femoropopliteal arteries.

RESUMEN

INTRODUCTION: Valve-reimplantation and remodelling techniques used in aortic reconstruction provide successful early, mid, and long-term results. We present our early and late-term experience with 110 patients with aortic regurgitation (AR) who underwent aortic valve repair (AVr) or valve-sparing aortic root surgeries (VSARS) due to aortic dissection or aortic aneurysm. METHODS: Nine hundred eighty-two patients who underwent aneurysm or dissection surgery and aortic valve surgery between April 1997 and January 2017 were analysed using the patient database. A total of 110 patients with AR who underwent AVr or VSARS due to aortic dissection or aortic aneurysm were included in the study. RESULTS: In the postoperative period, a decrease was observed in AR compared to the preoperative period (P<0.001); there was an increase in postoperative ejection fraction (EF) compared to the preoperative values (P<0.005) and a significant decrease in postoperative left ventricle diameters compared to the preoperative values (P<0.001). Kaplan-Meier analysis revealed one, two, four, and five-year freedom from moderate-severe AR as 95%, 91%, 87%, and 70%, respectively. Freedom from reoperation in one, two, and five years were 97.9%, 93.6%, and 81%, respectively. Eight patients (7.4%) underwent AVr during follow-up. Out of the remaining 100 patients, 13 (12%) had minimum AR, 52 (48%) had 1st-2nd degree AR, and 35 (32%) had 2nd-3rd degree AR during follow-up. CONCLUSION: For the purpose of maintaining the native valve tissue, preserving the EF and the left ventricular end-diastolic diameter, valve-sparing surgeries should be preferred for appropriate patients.

Asunto(s)

RESUMEN

OBJECTIVE: To present the early and mid-term results of PTA for femoropopliteal lesions in diabetic patients, performed by the cardiovascular surgeons. STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Department of Cardiovascular Surgery, Ankara City Hospital, Turkey, from August 2015 to April 2018. METHODOLOGY: Seventy-nine patients with diabetes mellitus (DM) and lower limb arterial occlusive disease underwent endo-interventions causing Rutherford Class 2-5 pedal ischemia. Study end points included ankle brachial index (ABI) and primary patency (PP) evaluated through Kaplan-Meier analyses. RESULTS: The technical success rate was 92.4% with a mean follow-up period of 13.3 ± 9.2 months. Bailout stenting was required in 27 (34.2%) of the lesions and only 7 (8.9%) patients required percutaneous reintervention at the end of the follow-up period. Kaplan-Meier analysis of the bailout stenting group revealed higher primary patency and lower reintervention rates at 24 months when compared with the PTA group (70.8%, 57.7%  and 80.5% 65.9%, respectively). CONCLUSION: Endovascular procedures can be performed by cardiovascular surgeons in the early and mid-term with high success and low complication rates in patients with diabetes mellitus. Key Words: Percutaneous transluminal angioplasty, Endovascular arterial intervention, Diabetes, Femoro-popliteal occlusion, Revascularisation, Lower limb arterial occlusion.

Asunto(s)

RESUMEN

Determining the optimal length of artificial chordae tendineae and then effectively securing them is a major challenge in mitral valve repair. Our technique for measuring and stabilizing neochordae involves tying a polypropylene suture loop onto the annuloplasty ring. We used this method in 4 patients who had moderate-to-severe mitral regurgitation from degenerative posterior leaflet (P2) prolapse and flail chordae. Results of intraoperative saline tests and postoperative transesophageal echocardiography revealed only mild insufficiency. One month postoperatively, echocardiograms showed trivial regurgitation in all 4 patients. We think that this simple, precise method for adjusting and stabilizing artificial chordae will be advantageous in mitral valve repair.

Asunto(s)

RESUMEN

Behçet's disease is a vasculitic pathology characterized by skin lesions, genital ulcers, aphthous stomatitis, and uveitis. Arterial aneurysms are rare in this disease. Herein, we report a rare case of an isolated brachial artery aneurysm with a history of Behçet's disease treated with endovascular covered stenting of the brachial artery.

RESUMEN

BACKGROUND: Childhood obesity (CO) is a high priority issue due to its serious health consequences and its rapid increase. OBJECTIVES: To examine the views of primary care physicians (family physicians, FPs) in Turkey regarding their role in the management of CO and the barriers they perceive. METHODS: Mixed methods approach. Data was collected in two major counties of Istanbul between February and May 2014. All Family Health Centres (FHCs) in the region were visited, and 180/284 FPs (63.4%) agreed to complete a structured questionnaire (22 questions). Of those, 48 FPs agreed to participate in in-depth interviews that were taken until saturation was 25. Quantitative data were analysed using descriptive statistics. For qualitative data, content analysis was applied to identify the themes. RESULTS: Most of the FPs (93.3%) agreed that they have a role in managing CO. Almost all FPs (98.3%) agreed that for the 0-4-year-olds height and weight measures should be taken. However, only 67.6% recommended this for children aged 5-15 years. The most common barriers in the management of CO were reported as lack of time (68.9%) and FHCs not being utilized for the care of children aged 5-15 years old (53.3%) in Turkey. In-depth interviews showed that FPs tend to limit their role to identifying the problem and making the family aware of it. CONCLUSION: Although FPs recognize primary healthcare as an appropriate setting for managing CO, they have concerns about being involved in the treatment.

Asunto(s)

RESUMEN

OBJECTIVES: To investigate aortic stiffness and subclinical left ventricular systolic dysfunction in ankylosing spondylitis (AS) patients. METHODS: A cross-sectional study of 55 AS patients being treated with antitumor necrosis factor alpha (anti-TNF-α) biological agents, conventional synthetic disease-modifying antirheumatic drugs (csDMARDS), and non steroidal anti-inflammatory drugs (NSAIDs) and 20 controls matched for conventional cardiovascular risk factors. Aortic stiffness, ejection fraction, and left ventricular global longitudinal strain (LVGLS) were evaluated using transthoracic echocardiography and 2D Doppler echocardiography. RESULTS: Aortic stiffness was higher in AS patients when compared to controls (P = 0.009). Stiffness increased in those being treated with csDMARDs when compared to the control group and those on anti-TNF-α biologics (P ˂0.001). AS patients' LVGLS values were worse than those of the control group (P < 0.001) and also worse in patients on csDMARDs and anti-TNF-α biologics when compared to those being treated with NSAIDs (P < 0.001). CONCLUSIONS: Subclinical cardiac dysfunction occurs in AS patients despite well controlled musculoskeletal disease. Aortic stiffness and LVGLS increases in AS patients. Anti-TNF biological agents may somewhat protect arterial compliance. We believe that all AS patients should be investigated for cardiac dysfunction and followed up accordingly.

Asunto(s)

RESUMEN

BACKGROUND: This study aims to investigate the effects of various anticoagulant regimens on prosthetic valve-related complications and pregnancy outcomes including feto-maternal mortality and morbidity, and to identify the most optimal anticoagulation therapy regimen. METHODS: Anticoagulant therapy regimens for pregnant women who underwent mechanical heart valve replacement between January 1990 and December 2015 was analyzed retrospectively. Seventy-two pregnancies among 57 patients after mechanical heart valve replacement were reviewed, and four different regimens were identified and evaluated during different trimesters of pregnancy. RESULTS: Forty of 72 pregnancies resulted in healthy newborns; 35 (48.6%) healthy neonates, four (5.6%) premature births, and one (1.4%) low birth weight. Eighteen (25%) therapeutic and 12 (16.7%) spontaneous abortions, as well as two (2.8%) stillbirths occurred. Seven valve thromboses developed during pregnancy or the postpartum period. Bleeding occurred in six patients (10.5%) and peripheral embolism also occurred in six patients (10.5%). No maternal mortalities were recorded. CONCLUSION: Although there is no consensus on the most optimal anticoagulant regimen during pregnancy, substituting warfarin with dose-adjusted unfractionated heparin or low-molecularweight heparin seems suitable to prevent teratogenicity and a high abortion rate in the first trimester. Low-molecular-weight heparin is practical to use and can be monitored reliably, resulting in successful pregnancy outcomes. However, warfarin throughout pregnancy ≤5 mg per day may be an alternative choice, if the risk of embryopathy is accepted by the pregnant woman.

RESUMEN

The role of second hand smoke (SHS) exposure on ulcerative colitis is not known. Our aim was to examine the effects of α-lipoic acid (ALA), chronic aerobic (AE) or resistance exercise (RE) on SHS exposed rats with colitis. Sprague-Dawley male rats (150-200 g, n=54) were selected for colitis induction. Among the colitis groups, one group was exposed to SHS (6 d/wk, 4 cigarettes/d) and the other was not. The SHS group was divided into subgroups as follows: sedentary; AE (swimming; 3 d/wk); and RE (climbing with weight; 3 d/wk). After 5 weeks, colitis was induced by intrarectal acetic acid. All groups had subgroups that were given subcutaneously ALA (50 mg/kg per day) or vehicle for 3 days. Following decapitation, colon tissues were sampled to examine malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity, luminol and lucigenin chemiluminenscence, macroscopic scoring and histologic examination. ANOVA and Student's t-test were used for statistical analysis. The increased macroscopic and microscopic scores, MPO, MDA, luminol and lucigenin measurements in colitis and SHS-colitis groups were decreased via ALA (P<.05-.001). AE declined macroscopic and microscopic scores, MDA, lucigenin compared to colitis and SHS-colitis groups (P<.01-.001). RE reduced microscopic score, MPO, MDA, luminol, lucigenin (P<.05-.001) that were increased with colitis. Decreased GSH levels (P<.01) in the SHS-colitis group approached to control levels when given ALA. According to our results SHS and colitis induction increased inflammatory damage. SHS did not worsen it more than colitis. Our results suggest that ALA, AE or RE might be protective for SHS exposed ulcerative colitis conditions.

Asunto(s)

RESUMEN

The aim of this study was to compare the graft patency rates among patients who had a previous history of percutaneous coronary intervention (PCI) followed by coronary artery bypass grafting surgery (CABG) with the patients who had experienced CABG surgery alone. The 69 patients who were included in the study had a history of bare metal stent implantation prior to CABG (group 1). The coronary angiography results were compared with 69 patients who had a previous history of CABG (group 2). Graft patency rates of the left anterior descending artery and circumflex anastomoses are statistically significant for both groups, whereas the right coronary artery anastomoses are not statistically significant (p = 0.008; 0.009; 0.2). Graft patency rate of LIMA-LAD anastomoses was 43.9 ± 10.8 % in group 1 and 86.2 ± 6 % in group 2 for means of 60 months (p = 0.0001) and circumflex coronary artery anastomosis is 28.9 ± 0.9 % in group 1, 65.7 ± 10.8 % in group 2 (p = 0.0001) and the right coronary artery anastomosis is 37.2 ± 13.6 % in group 1, 56.4 ± 8.9 % in group 2 (p = 0.0001). The graft patency rates of coronary arteries without previous stent implantation were higher than the patients with previous stent implantation and experienced CABG. The results suggest that prior PCI may induce atherosclerotic events in the vessel that can adversely affect graft patency after surgery.

Asunto(s)

RESUMEN

BACKGROUND: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. METHODS: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. RESULTS: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). CONCLUSION: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs.