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Surgical treatment is recommended in patients with symptomatic severe tricuspid regurgitation and pulmonary regurgitation. Although renal transplant patients are a high-risk patient group for cardiac surgery, heart valve surgeries can be performed successfully. There are a limited number of studies published on this subject in the literature. Therefore, we present a case who underwent tricuspid ring annuloplasty (TRA) before being followed up with renal transplantation and then successfully performed redo tricuspid valve replacement (TVR) and pulmonary valve replacement (PVR)., Competing Interests: None declared., (© Copyright 2024 by The Medical Bulletin of Sisli Etfal Hospital.)

Objective: Microsurgery has made great contributions to the advancement of surgery. In parallel with the developments in microsurgery, various techniques have been developed to perfect the technique. Microvascular anastomotic coupler device (MACD) is one of these techniques. The aim of the study was to evaluate the effectiveness of anastomoses created by using hand-sewn microsurgery (HSM) and MACD., Methods: Twenty male Sprague-Dawley rats weighing 250 to 300 g were divided into 2 groups randomly. Arteriovenous shunt was performed between carotid artery and internal jugular vein with the principles of HSM in the first group (n=10) and by using the 1-mm anastomotic microvascular device in the second group (n=10). Groups were evaluated for anastomose time, success of anastomosis, thrombosis formation, color Doppler ultrasonography, and histopathological features., Results: Anastomotic time was faster with the coupler device compared with HSM technique. Flow rates were found significantly higher in the MACD group. Endothelialization and wall integrity rates were better in MACD group., Conclusions: Microvascular anastomotic coupler device is faster than HSM. High quality and durability of vascularization, insignificant foreign body reactions are histopathological advantages of MACD., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Background: Platelet dysfunction has been shown to play a role in postoperative bleeding, however it is not clear whether immature platelets (IP) can induce appropriate homeostasis to prevent excessive bleeding in patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to evaluate the postoperative change in IP count (IPC), IP fraction (IPF) and mean platelet volume (MPV), and to examine their relationship with postoperative bleeding and blood transfusion., Methods: One hundred and forty-nine consecutive patients undergoing elective CABG were included in this prospective study. All CABGs were performed by the same surgical team in a standardised method, utilising the on-pump technique. IPC, MPV and IPF were measured pre-operatively, after the completion of surgery, and at the postoperative first, third and fifth days. The primary outcome measure of this study was whether the need for transfusion was associated with IP, IPF, MPV and platelet count., Results: There was a significant decrease of 7.77% in IPC on the day of the operation. Pre-operative IPC and IPF were correlated with postoperative drainage ( p < 0.001), intraoperative blood transfusion ( p < 0.001) and intensive care unit blood transfusion ( p < 0.001). Pre-operative haemoglobin levels were significantly correlated with length of hospital stay. However, neither pre-operative IPC nor IPF were associated with length of hospital stay. Postoperative IPC was however associated with the length of hospital and intensive care unit stay ( p = 0.008 and p = 0.009, respectively)., Conclusions: Pre-operative IPC and IPF were significantly correlated with postoperative drainage and blood transfusion frequency. In patients undergoing CABG, these can be seen as serious guiding parameters in the estimation of postoperative bleeding.

Objective/introduction: Near-infrared spectroscopy (NIRS) is a non-invasive technique to detect cerebral ischemia by monitoring changes in regional cerebral oxygenation (rSO2) in the frontal lobes. However, there are no studies showing the changes in NIRS values in response to hemodynamic variations during stages of carotid endarterectomy (CEA) procedure and clinical implications of these changes. The aim of this study was to determine if hemodynamic changes affect NIRS values during carotid endarterectomy and if our results may help to provide strategies for hemodynamic management in these patients., Methods: A total of 50 consecutive patients undergoing CEA were prospectively included in the study. NIRS was measured at first minute after clamping of carotid artery, and then systolic blood pressure was increased above 150 mmHg. NIRS values from both hemispheres were recorded simultaneously at certain time points and were analyzed to evaluate the changes at different stages of operation and to assess correlations with hemodynamic parameters., Results: NIRS values on the right and left sides were correlated with systolic (right P<0.001, R2:0.24; left P=0.02, R2:0.10) diastolic (right P<0.001, R2:0.36; left P=0.001, R2:0.18) and mean (right P<0.001, R2:0.33; left P=0.003, R2:0.17) blood pressures when the patient was under general anaesthesia. NIRS values were significantly lower than pre-incision values just after clamping of carotid artery in both hemispheres (P=0.005 for the right and P<0.001 for the left side)., Conclusion: NIRS values measured in our study show that there is a correlation between hemodynamic changes and cerebral oxygenation. This effect is especially pronounced while the patient is asleep and intubated, which implies the importance of close monitoring of patients with carotid disease during any surgery requiring general anaesthesia.