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Öğe Adverse effects of cell saver in patients undergoing ruptured abdominal aortic aneurysm repair(Elsevier Science Inc, 2002) Posacioglu, H; Apaydin, AZ; Islamoglu, F; Calkavur, T; Yagdi, T; Atay, Y; Buket, SA retrospective analysis of 56 patients undergoing ruptured abdominal aortic aneurysm (AAA) repair was performed to find out if cell saver had any impact on postoperative morbidity and mortality. All patients but one were male. The mean age was 68 +/- 8 years (35-85 years). Cell saver was used in 40 patients (CS group) and was not used in 16 patients (NCS group). We compared the incidences of respiratory, renal, and gastrointestinal complications; reoperation; transfusion requirement; length of hospital stay; and mortality between the groups. This study demonstrated that intraoperative cell saver usage significantly increased the incidence of respiratory complications and the need for blood and fresh frozen plasma transfusion, and prolonged the hospital stay in patients with ruptured AAA, but did not have any impact on mortality. Postoperative complications were more prominent in patients who received greater than or equal to3000 mL cell saver blood.Öğe Analysis of perioperative risk factors in mortality and morbidity after modified Bentall operation(Japan Heart Journal, Second Dept Of Internal Med, 2002) Apaydin, AZ; Posacioglu, H; Islamoglu, F; Calkavur, T; Yagdi, T; Buket, S; Durmaz, IThe objective of the present study was to determine the risk factors for operative and short-term mortality, and morbidity after a Bentall operation, Between July 1994 and February 2001, 86 consecutive patients (70 males) Underwent a modified Bentall operation at our hospital. The aortic pathology was acute aortic dissection in 12 (14%), chronic dissection in 9 (10.5%) and degenerative aneurysm in 65 (75.6%). Mean age was 48 +/- 15 years. Eleven preoperative, 8 intraoperative and 6 postoperative variables of these patients were retrospectively analyzed using univariate and multivariate logistic regression analysis. Six patients died in the hospital (6.9%) and 2 died within four months after being discharged from the hospital. Mean follow-up time was 33 23 months (2 months to 8 years). The survival rate among hospital survivors was 88% at 3 years and 77% at 6 years. Univariate predictors of in-hospital and short-term mortality were the presence of aortic valve calcification, stenotic aortic valves, renal failure, and cardiac failure after the operation. Multivariate analysis revealed no independent risk factors. Risk factors for morbidity were etiology of acute dissection, use of circulatory at-rest, transfusion of blood and fresh frozen plasma more than 2 units each, cross clamp and cardiopulmonary bypass times (exceeding 90 and 140 minutes, respectively), and performing concomitant procedures. Modified Bentall procedures are safe in general. Meticulous dissection, careful handling and positioning of the coronary buttons are of paramount importance in patients with stiff aortic root since technical errors are more likely to occur.Öğe Arch-first technique used with commercial T-graft to treat subacute type-A aortic dissection in patient with Marfan syndrome(Texas Heart Inst, 2002) Apaydin, AZ; Posacioglu, H; Yagdi, T; Islamoglu, F; Calkavur, T; Buket, SStaged repair of extensive thoracic aortic aneurysms puts certain patients at risk of rupture. We report the case of a patient with Marfan syndrome who presented with subacute type-A aortic dissection and a large descending aortic aneurysm. We used the arch-first technique with a commercially available Dacron T-graft. A clamshell incision was used for exposure. A button of arch vessels was anastomosed to the T-graft. Antegrade cerebral perfusion was established through the side branch. The distal end of the graft was anastomosed to the descending aorta and the proximal end to a composite graft. The duration of cerebral ischemia was 30 minutes; antegrade cerebral perfusion lasted 52 minutes. The patient experienced no neurologic dysfunction and was discharged with no major deficit. This technique shortens brain-ischemia time and is a good option if the risk of rupture of the descending component of an extensive thoracic aortic aneurysm is high. To the best of our knowledge, this is the 1st reported case in which the arch-first technique has been used with a commercially available T-graft to treat subacute type-A aortic dissection in a patient with Marfan syndrome.Öğe Cerebral perfusion through separate grafts for repair of acute aortic dissection with torn arch(Texas Heart Inst, 2001) Apaydin, AZ; Posacioglu, H; Calkavur, T; Islamoglu, F; Uc, H; Buket, SWe have modified the technique of cerebral perfusion through anastomosed grafts for repair of acute arch dissections that require total arch replacement. We have performed this operation on a 71-year-old man with an acute type-A dissection and an arch tear between the orifices of the brachiocephalic arteries, We used 2 separate grafts for the brachiocephalic arteries and minimized brain Ischemia by initiating antegrade selective cerebral perfusion after the 1st anastomosis. The patient had an excellent outcome. This method is simple and provides effective protection. Cerebral ischemic time can be kept under 30 minutes without need of a sophisticated pump setup or a multibranched graft, This affords extra time in case the surgeon encounters an unexpected lesion in the arch.Öğe Composite graft endocarditis - Repair with a mechanical prosthesis(Texas Heart Inst, 2004) Apaydin, AZ; Posacioglu, H; Islamoglu, F; Degirmenciler, K; Durmaz, IWe report the case of a 64-year-old man who developed a mediastinal pseudoaneurysm due to severe endocarditis, 2 years after aortic root replacement with a prosthetic composite graft containing a mechanical valve. After a short period of stabilization and antibiotic therapy, the patient underwent surgery. The coronary buttons and the sewing ring of the composite graft were found to be detached from the graft and the annulus, respectively. Re-replacement with a prosthetic composite graft (Dacron graft with a mechanical valve) by the Cabrol procedure was performed. Although the homograft is considered by many surgeons to be the best graft for aortic root replacement, the synthetic composite graft can also be used to treat composite graft endocarditis successfully. The technical aspects of homograft versus synthetic aortic root replacement in patients with endocarditis are discussed briefly.Öğe Coronary artery bypass grafting in patients with poor left ventricular function(Japan Heart Journal, Second Dept Of Internal Med, 2002) Islamoglu, F; Apaydin, AZ; Posacioglu, H; Ozbaran, M; Hamulu, A; Buket, S; Telli, A; Durmaz, ICoronary artery bypass grafting (CABG) in patients with poor left ventricular function remains a surgical challenge and is still controversial. The purposes of this study were to evaluate the effectiveness of CABG in such patients when performed without case selection on the basis of preoperative viability tests and to determine the predictors of postperative outcome. The preoperative, perioperative, and postoperative early and mid-term follow-up data of 273 patients with less than or equal to30% left ventricular ejection fraction (LVEF) who underwent isolated CABG between January 1995 and November 2000 were evaluated. Preoperative echocardiography and cardiac catheterization, and postoperative control echocardiography were performed in all patients. Follow-up was achieved via monthly periodical examinations in the first 6 months, and thereafter by either regular visits or phone contact. Preoperatively, 242 (88.65%) patients were in NYHA class III or IV, and the mean LVEF was 26.51 +/- 3.64%. The overall hospital mortality total was 14 (5.13%) patients. There were 44 (16.12%) late mortalities. Postoperative morbidities were observed in 74 (27.1%) patients. Two-hundred and two (93.95%) of the surviving 215 (78.75%) patients were in NYHA class I or II at 49.55 +/- 14.84 months of follow-up. Postoperative follow-up echocardiographic examinations revealed a mean LVEF of 39.66% +/- 5.43% The improvements in functional capacity and LVEF were significant. Advanced age, diabetes, hypertension, cross-clamp time >60 min, bypass time>120 min, and severity of functional class (class III-IV of NYHA) were found to be the determinants of mortality. However, multivariate analyses revealed only older age and class III-IV of NYHA and CCS were predictors of mortality. The low mortality and morbidity rates as well as satisfactory postoperative improvements in functional capacity and LVEF measurements support the use of CABG without the need for any viability assessment in patients with left ventricular dysfunction.Öğe Detachment of the mitral anterior leaflet as a complication of aortic valve replacement(Texas Heart Inst, 2006) Islamoglu, F; Apaydin, AZ; Degirmenciler, K; Gurgun, C; Durmaz, IMitral regurgitation after aortic valve replacement is generally reported as a complication of a Manouguians procedure for annulus enlargement. However even if no annular enlargement procedure is performed, this complication may be encountered after isolated aortic valve replacement because of either extensive decalcification of the aortic annulus or progressive tension on the anterior leaflet of the mitral valve, caused by aortic valve sutures placed adjacent to firm or heavily calcified valve tissue. Routine transthoracic echocardiography may be inadequate for diagnosis of this condition; transesophageal echocardiography should be used both for preoperative diagnosis and for intraoperative management. We report the case of a patient who had severe mitral regurgitation that occurred after aortic valve replacement with a mechanical valve.Öğe Pear-shaped multiple iliac artery aneurysms(Texas Heart Inst, 2002) Posacioglu, H; Apaydin, AZ; Yuntem, N; Durmaz, IÖğe Perigraft to right atrial shunt by using autologous pericardium for control of bleeding in acute type A dissections(Elsevier Science Inc, 2002) Posacioglu, H; Apaydin, AZ; Calkavur, T; Yagdi, T; Islamoglu, FBackground. We report our experience with creating a perigraft to right atrial fistula by using autologous pericardium to control the inaccessible bleeding after aortic root repair in patients with acute type A aortic dissection. Methods. Between 1994 and 2001, perigraft to right atrial fistula was used in 7 of 109 patients (mean age; 55 years) who underwent emergency operation for acute type A dissections. A chamber around the aortic graft was created by suturing a patch of pericardium to the right ventricular wall inferiorly, to the pulmonary artery medially, to the Teflon felt at the distal aortic anastomosis or innominate vein superiorly, and to the superior vena cava and right atrium laterally. A large stab wound was created on the medial aspect of the right atrium. The perigraft space was then closed expeditiously. Results. None of these patients required reexploration for bleeding and they were discharged from the hospital without complications. The average blood and fresh frozen plasma requirement was 3.4 +/- 0.9 and 2.7 +/- 0.7, respectively. All underwent echocardiographic examination before discharge and no perigraft to right atrial shunt was detected. Conclusions. If intractable bleeding is encountered after the administration of protamine and thrombotic agents and a discrete bleeding site can not be found, then a perigraft to right atrial fistula using autologous pericardium can be created as a last resort. It provides primary and definite sternal closure and avoids the detrimental effects of a second pump run and continued bleeding.Öğe Perioperative determinants of mortality and morbidity in distal arch and proximal descending aortic aneurysm surgery(Int Scientific Information, Inc, 2004) Islamoglu, F; Posacioglu, H; Apaydin, AZ; Calkavur, T; Yagdi, T; Ataym, Y; Atay, Y; Buket, SBackground: The purpose of this article is to describe our experience on distal arch and proximal descending aortic aneurysm repair, and to evaluate retrospectively the determinants of mortality and morbidity. Materials/Methods: Between 1994 and 2002, 30 patients (mean age 53.4 years) underwent repair of distal arch or proximal descending aortic aneurysm approached through left thoractomy with deep hypothermic circulatory arrest. Femoro-femoral bypass was used in all patients except for four, in whom the left subclavian artery was cannulated. Retrograde cerebral perfusion was performed in 16 patients. The mean circulatory arrest time was 30.7 min. Results: Overall hospital mortality was 13.3%. Excessive blood (p = 0.008) and plasma (p = 0.009) transfusions, and coronary artery disease (p = 0.012) were correlated with mortality. The overall rate of postoperative complications was 30%. Renal failure and respiratory failure were the most frequent complications (16.7%), while the rates of stroke and transient neurological dysfunction were 6.7% and 3.3%, respectively. Age > 70 years, bypass time > 140 min, distal ischemia time > 55 min, and excessive blood or plasma transfusions were determinants of postoperative complications. Conclusions: Deep hypothermic circulatory arrest with left thoracotomy is a valid procedure with acceptable mortality rates in the management of aneurysms of distal arch and proximal descending aorta. Prolonged bypass and distal ischemia times and excessive blood transfusions are associated with increased postoperative morbidity.Öğe Perioperative risk factors for mortality in patients with acute type A aortic dissection(Elsevier Science Inc, 2002) Apaydin, AZ; Buket, S; Posacioglu, H; Islamoglu, F; Calkavur, T; Yagdi, T; Ozbaran, M; Yuksel, MBackground. This study was undertaken to identify the perioperative risk factors for death in patients with acute type A aortic dissection (AADA). Methods. Between 1993 and 2001, 108 consecutive patients (86 men; mean age, 53 years) underwent emergent operations for AADA. All patients but 2 underwent replacement of the ascending aorta with an open distal anastomosis during a period of hypothermic circulatory arrest. In addition, 22 patients had hemiarch and 5 had total arch replacement. Aortic root was replaced in 20 and repaired with gelatin-resorcinol-formaldehyde glue in 39 patients; aortic valve was separately replaced in 3, resuspended in 24, and remained untouched in 22 patients. Results. Overall in-hospital mortality was 25%. Mortality rate was significantly higher in patients with preoperative dissection complications than in those without (21/36 [58%] vs 6/72 [8%], p < 0.001). In multivariate analysis, predictors of mortality were presence of rupture, renal failure, and intestinal malperfusion, duration of cardiopulmonary bypass &GE;200 minutes, blood loss &GE;500 mL, and transfusion of blood &GE;4 units. Location of the intimal tear, extent of the replacement, type of the aortic root repair, and duration of hypothermic circulatory arrest did not emerge as predictors of mortality. Conclusions. Major determinants of surgical mortality in patients with AADA are preoperative complications. Earlier diagnosis remains essential to improve the survival rate.Öğe A practical tool to control bleeding during sternal reentry for pseudoaneurysm of the ascending aorta(Elsevier Science Inc, 2003) Apaydin, AZ; Posacioglu, H; Islamoglu, F; Telli, ABig pseudoaneurysms of the ascending aorta after a previous thoracic operation are rare and represent a surgical challenge. Because the rupture during sternal reentry occurs before the clamp-control of the distal ascending aorta, it is essential to control the bleeding until the adhesions are released in order to place the sternal retractor. We report the use of Foley catheter with a malleable guidewire to control the bleeding from the defect in the ascending aorta causing a pseudoaneurysm in case of a limited access. (C) 2003 by The Society of Thoracic Surgeons.Öğe A practical tool to control bleeding during sternal reentry for pseudoaneurysm of the ascending aorta(Elsevier Science Inc, 2003) Apaydin, AZ; Posacioglu, H; Islamoglu, F; Telli, ABig pseudoaneurysms of the ascending aorta after a previous thoracic operation are rare and represent a surgical challenge. Because the rupture during sternal reentry occurs before the clamp-control of the distal ascending aorta, it is essential to control the bleeding until the adhesions are released in order to place the sternal retractor. We report the use of Foley catheter with a malleable guidewire to control the bleeding from the defect in the ascending aorta causing a pseudoaneurysm in case of a limited access. (C) 2003 by The Society of Thoracic Surgeons.Öğe Predictive value of conventional computed tomography in determining proximal extent of abdominal aortic aneurysms and possibility of infrarenal clamping(Texas Heart Inst, 2002) Posacioglu, H; Islamoglu, F; Apaydin, AZ; Parildar, M; Yagdi, T; Calkavur, T; Buket, SThe present study aimed to evaluate the diagnostic reliability of computed tomography in determining the proximal extent of abdominal aortic aneurysms and the possibility of infrarenal clamping. Preoperative computed tomographic findings, together with the operative data for 95 patients, were retrospectively analyzed in light of the operative findings. Eighty-nine (93.68%) of the patients were men and 6 (6.32%) were women, with a mean age of 66.27 +/- 18.74 years. Diagnosis of infrarenal aneurysm by computed tomography was confirmed at the time of surgery in 91 (95.79%) of 95 patients. The negative-predictive value of computed tomography in detecting supra-aneurysmal renal arteries was found to be 95.79%. The specificity was 98.91%. Infrarenal cross-clamping was performed in 59 (62.11%) of 95 patients, whose aortic segments between the renal artery orifices and the proximal borders of the aneurysms had a mean length of 26.4 +/- 7.11 mm by computed tomography. Suprarenal clamping was required in 36 (3789%) of the 95 patients, whose aortic segments had a mean length of 12.7 +/- 3.48 mm. We conclude that conventional computed tomography is reasonably accurate in determining the proximal extent of abdominal aortic aneurysms. Although there is a high rate of error in determining the possibility of infrarenal clamping when no specific measurements are taken, infrarenal clamping can be planned when measurement by computed tomography shows a length of 26 mm between the renal arteries and the proximal extent of the aneurysm. In patients with shorter aortic segments, suprarenal aortic clamping should be considered.Öğe Predictors of outcome in patients with prosthetic valve dysfunction(I C R Publishers, 2004) Islamoglu, F; Iyem, H; Apaydin, AZ; Ozbaran, M; Buket, S; Yuksel, M; Telli, A; Durmaz, IBackground and aim of the study: The study aim, based on the authors' experience in patients with prosthetic valve dysfunction, was to investigate risk factors for mortality and morbidity by analyzing preoperative, intraoperative and postoperative variables with respect to early and long-term survival. Methods: A retrospective analysis was carried out of 132 patients (47 men, 85 women; mean age 46.8 +/- 12.4 years) who presented for treatment of prosthetic valve dysfunction between December 1992 and February 2003. Two patients received thrombolytic therapy and were excluded from the statistical analysis, which comprised only operatively treated patients; four patients underwent successful surgical repair of mitral mechanical prostheses; all other patients (except two who died perioperatively) underwent prosthetic valve re-replacement (n = 124). Results: Overall mortality and hospital mortality rates were 15.2% and 10.6%, respectively. Postoperatively, 54 complications were seen in 42 patients (32.3%). Preoperative left ventricular endsystolic diameter (LVESD) greater than or equal to45 min and, cardiopulmonary bypass (CPB) time >140 min were independent risk factor's for overall and in-hospital mortality. Female gender, age >60 years and prolonged CPB time were predictors of postoperative complications. The actuarial survival rate was 87.5 +/- 0.3% at five years, and 81.7 +/- 0.4% at 10 years. A reduced left ventricular ejection fraction (LVEF) was the only independent predictor of late death and long-term survival. Conclusion: Preoperative LVESD 45 mm. and lower LVEF were found to be independent predictors of postoperative mortality and late survival, respectively. It is possible to obtain a substantial improvement in outcome and long-term survival if a valvular reoperation can be performed,with shorter CPB time and before left ventricular dysfunction has developed.Öğe Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery(Elsevier Science Inc, 2003) Durmaz, I; Yagdi, T; Calkavur, T; Mahmudov, R; Apaydin, AZ; Posacioglu, H; Atay, Y; Engin, CBackground. Preoperative creatinine values higher than 2.5 mg/dL are associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery. We aimed to determine the effects of prophylactic perioperative hemodialysis on operative outcome in patients with nondialysis-dependent moderate renal dysfunction. Methods. Forty-four adult patients with creatinine levels greater than 2.5 mg/dL but not requiring dialysis underwent coronary artery bypass surgery with cardiopulmonary bypass. The patients were randomly divided into two groups. In group I (dialysis group, 21 patients), perioperative prophylactic hemodialysis was performed in all patients. Group 2 (23 patients) was taken as a control group and hemodialysis was performed only if postoperative acute renal failure was diagnosed. Results. The hospital mortality was 4.8% (1 patient) in the dialysis group, and 30.4% (7 patients) in the control group (p = 0.048). Postoperative acute renal failure requiring hemodialysis was seen in 1 patient (4.8%) in the dialysis group and in 8 patients (34.8%) in the control group (p = 0.023). Thirty-three postoperative complications were observed in the control group for an early morbidity of 52.2% (12 patients) and 13 complications occurred in 8 patients in the dialysis group (38.1%). The average length of the intensive care unit and postoperative hospital stay were shorter in the dialysis group than in the control group (p = 0.005 and p = 0.023, respectively). Conclusions. Preoperative creatinine levels higher than 2.5 mg/dL, increase the risk of mortality and the development of acute renal failure and prolong the length of hospital stay after on-pump coronary artery bypass surgery. Perioperative prophylactic hemodialysis decreases both operative mortality and morbidity in these high-risk patients. (C) 2003 by The Society of Thoracic Surgeons.Öğe Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery(Elsevier Science Inc, 2003) Durmaz, I; Yagdi, T; Calkavur, T; Mahmudov, R; Apaydin, AZ; Posacioglu, H; Atay, Y; Engin, CBackground. Preoperative creatinine values higher than 2.5 mg/dL are associated with markedly increased risk for both mortality and morbidity in patients undergoing coronary artery bypass surgery. We aimed to determine the effects of prophylactic perioperative hemodialysis on operative outcome in patients with nondialysis-dependent moderate renal dysfunction. Methods. Forty-four adult patients with creatinine levels greater than 2.5 mg/dL but not requiring dialysis underwent coronary artery bypass surgery with cardiopulmonary bypass. The patients were randomly divided into two groups. In group I (dialysis group, 21 patients), perioperative prophylactic hemodialysis was performed in all patients. Group 2 (23 patients) was taken as a control group and hemodialysis was performed only if postoperative acute renal failure was diagnosed. Results. The hospital mortality was 4.8% (1 patient) in the dialysis group, and 30.4% (7 patients) in the control group (p = 0.048). Postoperative acute renal failure requiring hemodialysis was seen in 1 patient (4.8%) in the dialysis group and in 8 patients (34.8%) in the control group (p = 0.023). Thirty-three postoperative complications were observed in the control group for an early morbidity of 52.2% (12 patients) and 13 complications occurred in 8 patients in the dialysis group (38.1%). The average length of the intensive care unit and postoperative hospital stay were shorter in the dialysis group than in the control group (p = 0.005 and p = 0.023, respectively). Conclusions. Preoperative creatinine levels higher than 2.5 mg/dL, increase the risk of mortality and the development of acute renal failure and prolong the length of hospital stay after on-pump coronary artery bypass surgery. Perioperative prophylactic hemodialysis decreases both operative mortality and morbidity in these high-risk patients. (C) 2003 by The Society of Thoracic Surgeons.Öğe Pseudoaneurysm and aortobronchial fistula - after aortic coarctation repair by patch aortoplasty(Texas Heart Inst, 2004) Posacioglu, H; Apaydin, AZPseudoaneurysm and aortobronchial fistula are very rare complications of aortic coarctation repair by means of patch aortoplasty, and are usually fatal if not treated surgically. A 26-year-old man with recent-onset massive hemoptysis had undergone aortic coarctation repair by means of Dacron patch aortoplasty at the age of 10 in our hospital. Computed tomography of the chest showed a descending aortic pseudoaneurysm. Left heart bypass was used for distal perfusion while the patient underwent graft interposition. Lung parenchyma around the fistula was repaired, and the patient was discharged after an uneventful postoperative course. When hemoptysis occurs in a patient with a history of thoracic aortic surgery, aortobronchial fistula should be suspected. Close follow-up is mandatory for patients who have undergone coarctation repair.Öğe Regional lidocaine infusion reduces postischemic spinal cord injury in rabbits(Texas Heart Inst, 2001) Apaydin, AZ; Buket, SParaplegia secondary to spinal cord ischemia is a devastating complication in operations on the descending and thoracoabdominal aorta. We hypothesized that the tolerance of the spinal cord to an ischemic insult could be improved by means of regional administration of lidocaine. Thirty-one New Zealand white rabbits were anesthetized and spinal cord ischemia was induced by the placement of clamps both below the left renal vein and above the aortic bifurcation. The animals were divided into 5 groups. Aortic occlusion time was 20 minutes in Group 1 and 30 minutes in all other groups. Groups 1 and 2 functioned as controls. Lidocaine (Group 5) or normal saline solution (Group 3) was infused into the isolated aortic segment after cross-clamping. Group 4 animals received 20% mannitol regionally, before and after reperfusion. Postoperatively. rabbits were classified as either neurologically normal or injured (paralyzed or paretic). Among controls, 20 minutes of aortic occlusion did not produce any neurologic deficit (Group 1: 0/4 injured), while 30 minutes of occlusion resulted in more consistent injury (Group 2: 6/8 injured). Animals that received normal saline (Group 3) or mannitol (Group 4) regionally showed 80% neurologic injury (4/5), Animals treated with the regional lidocaine infusion (Group 5) showed much better neurologic outcomes (7/9 normal: 78%). This superiority of Group 5 over Groups 2, 3, and 4 was significant (P <0.02). We conclude that regional administration of lidocaine reduced neurologic injury secondary to spinal cord ischemia and reperfusion after aortic occlusion in the rabbit model.Öğe The role of brain natriuretic peptide in the prediction of cardiac performance in coronary artery bypass grafting(Texas Heart Inst, 2003) Saribulbul, O; Alat, I; Coskun, S; Apaydin, AZ; Yagdi, T; Kiliccioglu, M; Alayunt, EAThe relationship between brain natriuretic peptide and cardiopulmonary bypass has not been examined sufficiently In this study, we prospectively examined brain natriuretic peptide levels in the plasma of 26 patients undergoing coronary artery bypass grafting. Brain natriuretic peptide measurements were carried out at 4 times: preoperatively, 3 hours after institution of cross-clamping, 24 hours after institution of cross-clamping, and on the 5th postoperative day. In addition, we measured individual variables and compared them to brain natriuretic peptide levels. Mean preoperative brain natriuretic peptide levels were significantly higher in patients with histories of myocardial infarction (P = 0.0047) and heart failure (ejection fraction less than or equal to0.40) (P = 0.0001). There was a significant correlation between preoperative brain natriuretic peptide levels and cross-clamp times (P = 0.028), and an inverse correlation between those levels and preoperative cardiac indices (P = 0.001). The preoperative brain natriuretic peptide level also correlated inversely with left ventricular ejection fraction before (P = 0.001) and 5 days after (P = 0.01) operation. When the Clinical Severity Scoring System was applied, preoperative brain natriuretic peptide plasma concentrations in 19 patients with risk scores of 0-2 were significantly lower than in the 7 patients whose risk scores were 3-6 (P = 0.006). There was also a significant relationship between preoperative brain natriuretic peptide plasma concentrations and the postoperative requirement for inotropic agents (P = 0.027). This study suggests that plasma brain natriuretic peptide concentration could be one of the predictors of risk in patients undergoing coronary artery bypass grafting.
