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Purpose: Protective effect of pulsatile flow cardiopulmonary bypass (CPB) on the occurrence of acute renal injury is still a matter of debate. The objective of this study was to compare the effects of pulsatile and non-pulsatile cardiopulmonary bypass on kidneys using Urinary neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) as the markers of renal injury., Methods: 85 consecutive patients with normal preoperative renal function were prospectively enrolled in the study. Pulsatile perfusion (Group P) and non-pulsatile perfusion (Group NP) was used in 42 and 43 of the patients, respectively, during aortic cross-clamping period. NGAL and IL-18 were analyzed using ELISA in urine samples obtained preoperatively, and at 2, 12, and 24 h after CPB., Results: There was no significant difference between the groups in terms of perioperative renal function tests. IL-18 levels measured at 12 h after CPB were significantly lower in Group P, compared to Group NP (p<0.05). Urinary NGAL levels measured at 2 and 12 h were higher in Group NP; however, the difference was insignificant. In the subgroup of patients with a cross clamp time ≥45 minutes (pulsatile CPB, group P1, n = 33; non-pulsatile CPB, group NP1, n = 33), IL-18 levels measured at 12 hours after CPB were significantly lower in Group P1. Urinary NGAL concentrations measured at 2 and 12 hours in Group P1 were also significantly lower than that in Group NP1 (p = 0.048 and 0.043, respectively)., Conclusions: Low IL-18 and NGAL levels found in the pulsatile perfusion group might suggest the use of pulsatile flow resulted in better kidney protection.

Background: Total axilloaxillary cardiopulmonary bypass (CPB) is an alternative peripheral cannulation technique that has the advantages of antegrade flow during CPB, monohemispherical brain perfusion in case of circulatory arrest, and achieving excellent decompression of the heart during sternotomy. The results of this strategy, particularly beyond the immediately postoperative period, are not well known., Methods: Eleven patients with huge aortic aneurysms (>80 mm) and/or acute-subacute ascending aorta dissections underwent surgery with totally axilloaxillary CPB. Short- and midterm outcomes, including survival and complications relating to axilloaxillary cannulation, were reported., Results: All attempts at axillary artery cannulation were successful. Ten of the 11 axillary vein cannulation attempts were successful, and the target pump flow was achieved via the axillary vein alone. Postoperatively, clinical examinations revealed no cases of arm ischemia or compartment syndrome. Three patients (27.3%) experienced ipsilateral brachial plexus neuropathy that produced right hand weakness. The neuropathy was transient in 2 patients, and the symptoms resolved completely. Hospital death occurred in 1 (9.1%) of the 11 patients. The mean (±SD) follow-up time was 956 ± 292 days. One of the survivors died on postoperative day 105 from subacute graft infection and sepsis. The right arms of all 9 of the living patients were examined physically and by Doppler ultrasonography. We found a chronic recanalized thrombotic change in the subclavian vein in 1 patient (11.1%), who had no complaints., Conclusions: Axilloaxillary CPB is an alternative technique that can be used under certain conditions. Adding axillary venous cannulation to axillary artery cannulation at least does not increase the risk of a procedure that uses the axillary artery alone, either in the early or mid term.

Background: Coronary artery bypass grafting is applicable with very low mortality and morbidity rates around the world. However, exposure to even one of the risk factors increases mortality and morbidity significantly. There are three acute kidney injury definitions, and classification methods are applicable (Kidney Disease: Improving Global Outcomes (KDIGO); Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE);" (for accuracy) and Acute Kidney Injury Network (AKIN)), for understanding and grading of renal impairment. With these definitions, it became possible to take measures at an early stage and start the management process. Methods for assessing renal impairment after coronary artery bypass grafting (CABG) specifically in patients with diabetes mellitus require further investigation. We compared these three acute kidney injury definitions for prediction of outcomes in diabetic patients undergoing coronary artery bypass grafting procedure.Methods: Between January 2010 and December 2013, a total of 617 consecutive patients with diabetes mellitus undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass in our institution were included in the study.Results: We considered 617 CABG operations on diabetes mellitus patients for this study from January 2010 to December 2013. The three scores provided good discriminative capacity in the global patient sample, with the area under the ROC curve (AUC) being higher, RIFLE (0.803, 95% CI: 0.724-0.882). The goodness of fit was good for all scales.Conclusions: Especially in on-pump CABG patients with diabetes mellitus, we can use AKIN, RIFLE, and KDIGO scoring systems to predict early diagnosis for acute kidney injury (AKI). In our analysis, the KDIGO criterion was superior to AKIN and RIFLE with regard its prognostic power. [ABSTRACT FROM AUTHOR]

Background: The Cox-Maze IV procedure (CMP-IV) is considered the gold-standard surgical treatment for Atrial Fibrillation. Although this procedure adds some time to cross-clamp and cardiopulmonary bypass durations, it is not a significant concern when combined with a single primary operation such as isolated mitral valve surgery, aortic valve surgery, or coronary bypass surgery. Numerous studies have consistently shown excellent long-term outcomes with the combination of one primary operation and the Cox-Maze procedure. However, in developing countries, patients often require multiple primary operations in addition to the Cox-Maze procedure. This results in the Cox-Maze operation being performed as the third or subsequent procedure, potentially due to late referral or different underlying causes, such as rheumatic origin. Surgeons may hesitate to include the Cox-Maze procedure due to the added complexity and increased operative time, causing patients to miss their opportunity for effective treatment of atrial fibrillation. There is limited research available demonstrating the outcomes in this specific patient group. The aim of this study is to present the long-term outcomes of patients who underwent the Cox-Maze procedure as a third or subsequent procedure. Methods: Between November 2018 and January 2023, prospective data were collected from 34 patients who underwent concomitant CMP-IV surgery, with a minimum follow-up duration of six months. Freedom from atrial tachyarrhythmia (ATA) was assessed at 6 months, 1 year, and 2 years after surgery using 24-hour Holter ECG. Results: Among the patients, CMP-IV was the second procedure in 8 (23.5%) cases, the third procedure in 17 (50.0%) cases, the fourth procedure in 8 (23.5%) cases, and the fifth procedure in 1 (3.0%) case. One patient died 33 months after surgery due to intracranial hemorrhage. Three patients (8.8%) required permanent pacemakers (PP), and a total of 3 (8.8%) patients needed medical (2 patients) or DC cardioversion (1 patient) during the follow-up period. All 6 patients who required a PP or secondary intervention had undergone more than one procedure in addition to CMP-IV. At 6 months, freedom from AF was observed in 32 out of 34 patients (94.1%), at 1 year it was 25 out of 27 patients (92.6%), and at 2 years it was 19 out of 21 patients (90.5%). For patients who had the Cox-Maze procedure as a third or subsequent procedure, freedom from AF was observed in 24 out of 26 patients (92.3%) at 6 months, 18 out of 20 patients (90.0%) at 1 year, and 15 out of 17 patients (88.2%) at two years. Conclusion: The CMP-IV procedure demonstrates an acceptable long-term success rate for patients who required multiple primary operations, with additional secondary interventions and the need for permanent pacing. [ABSTRACT FROM AUTHOR]