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Objective: The mid-term patency rates for individual and sequential grafts as coronary bypass conduits for diagonal arteries were angiographically compared; the impact of native coronary vessel and type of the conduit characteristics are investigated. Methods: Between March 1992 and April 2000, we performed a total number of 811 distal anastomosis on diagonal arteries of left anterior descending (LAD) artery in 296 patients who underwent coronary artery bypass surgery (CABG) distal anastomosis in our clinic. The patients were divided into two groups in this prospective study. In group A (n = 195) individual anastomosis technique, in group B (n = 101) sequential anastomosis technique was chosen as the myocardial revascularization strategy. At an average of 49.4 ± 13.2 months after coronary revascularization procedure coronary angiographies were evaluated. Individual and sequential grafting techniques were compared by graft patency rates. Results: The patency rates of sequential conduits were markedly higher than those of individual conduits (66.7% vs. 89.2%, p = 0.0001). This difference was also clear in coronary arteries with poor quality and small (<1.5 mm) diameter (49.1% vs. 66.6%, p = 0.032). Also, the patency rates of sequential radial artery conduits were higher than sequential saphenous vein graft (SVG) conduits (sequential radial artery; 94.1%, sequential SVG; 85.3%, p = 0.043). Conclusions: Sequential grafting for diagonal artery is technically more demanding but the mid-term results are better than individual grafting especially in coronary arteries with poor quality. Using radial artery as a sequential graft increases the mid-term graft patency rates. [ABSTRACT FROM AUTHOR]

Background: Angiotensin-converting enzyme inhibitors, calcium channel blockers, and preoperative intravenous heparin use are independent risk factors for vasoplegic syndrome after cardiac surgery. We prospectively studied whether preoperative methylene blue administration would prevent the vasoplegic syndrome in these high-risk patients. Methods: One hundred patients scheduled for coronary artery bypass graft surgery who were at high risk for vasoplegia because they were preoperatively using angiotensin-converting enzyme inhibitors, calcium channel blockers, and heparin were randomly assigned to either receive preoperative methylene blue (group 1, n = 50) or not receive it (group 2, controls, n = 50). Methylene blue (1% solution) was administered intravenously at a dose of 2 mg/kg for more than 30 minutes, beginning in the intensive care unit 1 hour before surgery. Results: Although similar in terms of all demographic and operative variables, the two groups differed significantly in terms of vasoplegic syndrome incidence (0% in group 1[0 of 50] vs 26% in group 2 [13 of 50]; p < 0.001). In 6 patients, the vasoplegic syndrome was refractory to norepinephrine. Four of these patients survived; the other 2 had vasoplegic syndromes that were refractory to aggressive vasopressor therapy, and they ultimately died of multiorgan failure. Stroke occurred in 1 patient. The two study groups also differed significantly in terms of average intensive care unit stay (1.2 ± 0.5 days in group 1 vs 2.1 ± 1.2 days in group 2; p < 0.001) and average hospital stay (6.1 ± 1.7 days in group 1 vs 8.4 ± 2.0 days in group 2; p < 0.001). Conclusions: Our results suggest that preoperative methylene blue administration reduces the incidence and severity of vasoplegic syndrome in high-risk patients, thus ensuring adequate systemic vascular resistance in both operative and postoperative periods and shortening both intensive care unit and hospital stays. [Copyright &y& Elsevier]

Aim:To delineate whether coronary arteriovenous malformations have different properties than classical discrete coronary artery fistulae.Methods:Group 1 included 17 patients with discrete coronary fistula that represents a coronary artery fistula draining into any cardiac chamber. Group 2 included six patients with coronary arteriovenous malformations representing extensive coronary artery malformation. Cardiopulmonary bypass was used in 12 of the Group 1 patients and 5 in Group 2.Results:There was no operative mortality in either group. Following a hemodynamically nonsignificant residual fistulous communication, which was detected by repeat coronary angiography in Group 2; we changed our surgical technique of suture ligation on beating heart. Then we preferred pulmonary arteriotomy and sutured the orifice of coronary arteriovenous malformations from within the chamber.Conclusions:Coronary arteriovenous malformations have different morphology and also complex progression properties when compared with discrete coronary artery fistulae. Surgical repair of coronary arteriovenous malformation should be done by suturing the multiple drainage holes inside the draining chamber. Suture ligation of coronary arteriovenous malformation is difficult due to the fragile vessel.(J Card Surg 2005;20:124-128) [ABSTRACT FROM AUTHOR]

Background:Satisfactory results of bileaflet preserving mitral valve replacement (MVR) had forced several institutes to preserve both leaflets during MVR. Modifications were required to prevent the preserved tissue from interfering with prosthetic valve function, to implant an adequate size of valve and to prevent left ventricle outflow tract (LVOT) obstruction.Materials and Methods:Conventional MVR was performed to 51 patients (group 1) and bileaflet preserving MVR was performed to 43 patients (group 2). Mitral anterior leaflet incised from the middle of the leaflet to mitral annulus without chordal injury in group 2 patients. Sutures were placed through the mitral annulus first and then passed from the bottom to the tip of anterior leaflet. Posterior leaflet was also preserved. Prosthetic valve was put down into the mitral annulus and sutures were ligated. Excessive anterior leaflet tissue was attached to left atrial wall.Results:Cross-clamping time was 45± 5.33 minutes versus 61.32± 4.43 minutes (p= 0.0001) and total cardiopulmonary bypass time was 60.80± 4.44 minutes versus 80.55± 3.65 minutes (p= 0.0001) in groups 1 and 2, respectively. Inotropy requirement was higher in group 1 (p= 0.0058). When compared with preoperative values postoperative left ventricle ejection fraction (LVEF) increased both at rest (from 52.74%± 3.88% to 62.86%± 3.18%, p= 0.0001) and during exercise (from 53.16%± 3.16% to 64.11%± 2.46%, p= 0.0001) in bileaflet preserving MVR group. But in conventional MVR group LVEF decreased postoperatively both at rest (from 51.45%± 4.27% to 48.27%± 3.35%, p= 0.0001) and during exercise (from 54.47%± 7.36% to 42.96%± 3.58%, p= 0.0001).Conclusion:Leaflet preserving MVR operation not only improves the left ventricular performance but also reduces the mortality and morbidity after MVR. LVEF increases both at rest and during exercise. Risk of LVOT obstruction can be completely eliminated with our simple technique.(J Card Surg 2004;19:528-534) [ABSTRACT FROM AUTHOR]

Background: Lower ministernotomy has become a more popular approach for many heart operations. However, cannulation of the ascending aorta may causes serious complications. Femoral and brachial arteries have been used for alternative arterial cannulation sites. Materials and Methods: The lower ministernotomy approach was used in 65 patients. Ascending aortic cannulation was performed in group 1 (n = 38), femoral cannulation in group 2 (n = 12), and brachial cannulation in group 3 (n = 15) patients. Brachial artery diameter was measured preoperatively by Doppler ultrasound in the preoperative period. Results: Average cross-clamp time for femoral and brachial artery cannulated patient was significantly shorter than in patients in group 1 (31 ± 9 and 35 &plusmnl 6 minutes, respectively) (p = 0.037). Total cardiopulmonary bypass (CPB) time was 56 ± 11 minutes for group 1.39 ± 7 minutes for group 2, and 41 ± 5.4 minutes for group 3 (p = 0.041). Operation time was 112 ± 24, 88 ± 12, and 91 ± 11 minutes for the groups 1, 2, and 3, respectively. There was also statistically significant difference between group 1 and group 3 comparisons with regard to CPB time (p = 0.041). Difficult exposure from many cannulas impedes access and lengthens the operation in group I. Superficial wound infection developed in seven patients in group 1, one patient in group 2, and one patient in group 3. Conclusion: Cannulation of the brachial artery is superior to the femoral due to possible infection and lymph leakage with the latter and both are superior to central cannulation when lower ministernotomy is performed. By avoiding the difficulties of central aortic cannula placement the operative time is decreased and possible wound edge is protected as lesser exposure is required. [ABSTRACT FROM AUTHOR]

: BackgroundDivision of the sternum is primarily a blind procedure in reoperation and carries an increased risk of injury for major cardiac structures in the presence of adhesions between the posterior table and the heart.: MethodsTwo hundred patients were randomly divided into two groups. Cardiopulmonary bypass was established through the femoral artery and vein in group 1 (n = 100) patients before sternal reentry. Carpentier dual-stage femoral venous return cannula was used in all group 1 patients. Cardiopulmonary bypass was performed after sternal reentry in group 2 (n = 100) patients.: ResultsSix severe cardiac injuries developed in group 2. Cardiopulmonary bypass time was 93 ± 9 minutes in group 1 and 71 ± 11 minutes in group 2 (p = 0.011), and the operation time was 155 ± 23 minutes in group 1 and 185 ± 32 minutes in group 2 (p = 0.024). Inotropic therapy was required in 52 patients in group 1 and 76 patients in group 2 (p = 0.032). Average chest drainage was 450 ± 135 mL in group 1 and 850 ± 250 mL in group 2 (p < 0.001). Average fresh whole blood transfusion was 3.3 ± 1.2 U in group 1 and 5.8 ± 0.9 U in group 2 (p = 0.033). Average intensive care unit stay was 2.2 ± 1.3 days in group 1 and 4.5 ± 2.3 days in group 2 (p = 0.025). Average hospital stay was 7.3 ± 2.4 days in group 1 and 9.1 ± 3.1 days for group 2 (p = 0.011).: ConclusionsCardiopulmonary bypass by bicaval Carpentier femoral venous cannula before resternotomy not only allows adequate cardiopulmonary bypass flow but also significantly reduces the risk of cardiac injury and catastrophic hemorrhage and allows safe reopening. Although this procedure increases cardiopulmonary bypass time, the operation time, bleeding, and blood transfusion requirement are significantly reduced. [Copyright &y& Elsevier]

Compares early and intensive use of continuous veno-venous hemodiafiltration (CVVHDF) with conservative usage of CVVHDF in patients with acute renal failure (ARF) after cardiac surgery. Overall hospital mortality rate; Importance of the recognition of ARF and early beginning of the CVVHDF; Implications on nephrology and cardiovascular surgery.

Objective: Radial artery cannulation is a more difficult procedure in pediatric patients. Direct technique commonly fails in these patients, and several techniques have been developed for successful arterial cannulation. The purpose of this study was to compare direct radial artery cannulation with guidewire-assisted cannulation in children undergoing cardiac or aortic surgery. The hypothesis was that the guidewire-assisted technique would lead to fewer attempts and provide better long-term blood pressure monitoring and blood sampling. Materials and Methods: One hundred pediatric patients with congenital heart defects undergoing major cardiovascular surgery, who required a radial artery catheter, were included in the study. Patients were divided into 2 groups: group 1 included 50 patients who had radial artery cannulation with the direct technique, and group 2 included 50 patients who had a guidewire-assisted radial artery cannulation. Results: A radial artery was successfully cannulated in 48 patients in group 2 but only 38 patients in group 1. Mean elapsed time for radial artery cannulation was 22 ± 4.6 minutes in group 1 and 7 ± 4.2 minutes in group 2 (p = 0.001). The average number of attempts for cannulation was 4.5 in group 1 and 2.1 in group 2 (p = 0.022). The opposite radial or an alternative artery was used more commonly in the direct technique group. Satisfactory blood pressure monitoring and sampling of blood were obtained in 28 patients in group 1 and 46 patients in group 2 (p < 0.001). Conclusion: The authors recommend the use of a guidewire-assisted radial artery cannulation technique rather than a direct technique. The guidewire-assisted technique provided easy, safe, and quick cannulation and allowed for long-term satisfactory blood pressure monitoring and blood sampling because of the longer length of the Teflon catheter advanced into the artery over the guidewire, and a low rate of dissection of the radial artery. [Copyright &y& Elsevier]