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Acute intraoperative arterial elongation: an experimental study
(W B Saunders Co Ltd, 2001) Posacioglu, H; Yagdi, T; Atay, Y; Islamoglu, F; Calkavur, T; Durmaz, I
Objectives: small arterial defects resulting from either trauma or resection of an aneurysm often present difficult problems to the vascular surgeon. Design: to demonstrate that certain arterial gaps as a result of traumatic injury or aneurysm resection could be closed with acute intraoperative arterial elongation. Materials: fifteen mongrel dogs underwent acute intraoperative arterial elongation of the right superficial femoral artery, with the left side used for a control vessel. Methods: arterial defects created surgically (median 50 (range 25 to 60 mm) mm). Appropriate length of artery was then undermined. A Foley catheter was placed proximally and distally directly beneath this undermined portion of vessel. The vessel is lengthened following 3 expansion/relaxation cycle of Foley catheter. Arterial gaps were closed by end to end anastomosis. Arterial pressure study was performed in all vessels. Results: acutely, arterial pressure differences proximal and distal to the anastomosis were seen only when arterial gaps were exceeded 55 mm. There was no occlusion either acutely or after 4 weeks follow-up period. Light microscopic examination of arterial specimens revealed partial disruption of internal elastic lamina. At the end of the follow-up period, formation of neointima with regeneration of the internal elastic lamina was demonstrated. Scanning electron microscopy revealed minimal endothelial denudation. Conclusions: we believe that, acute intraoperative elongation can be used as an alternative technique to vein grafting for the repair of small traumatic arterial defects in selected cases.
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, S
A 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.
Allograft aortic root replacement for aortic valve endocarditis with aortopulmonary fistula
(Japan Heart Journal, Second Dept Of Internal Med, 2001) Calkavur, T; Yagdi, T; Islamoglu, F; Atay, Y; Nalbantgil, S; Ozbaran, M
Acute infective endocarditis affecting the aortic root and valve associated with development of a fistulous communication between the aorta and pulmonary artery was presented in a young Turkish girl. Emergency surgery was required. Operation consisted initially or closure of the defect on the main pulmonary artery with a pericardial patch. This was followed by allograft aortic root replacement.
Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting
(Mosby, Inc, 2003) Yagdi, T; Nalbantgil, S; Ayik, F; Apaydin, A; Islamoglu, F; Posacioglu, H; Calkavur, T; Atay, Y; Buket, S
Objective: The purpose of this study was to evaluate the safety and efficacy of postoperative administration of prophylactic amiodarone in the prevention of new-onset postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. Methods: In this prospective study 157 patients were randomly divided into two groups: 77 patients (amiodarone group) received intravenous amiodarone in a dose of 10 mg/kg/d for postoperative 48 hours. On postoperative day 2 oral amiodarone was started with a dose of 600 mg/d for 5 days, 400 mg/d for the following 5 days, and 200 mg/d for 20 days, and 80 patients received placebo (control group). Results: Preoperative patient characteristics and operative variables were similar in the two groups. Postoperative atrial fibrillation occurred in 8 patients (10.4%) receiving amiodarone and in 20 (25.0%) patients receiving placebo (P = .017). Duration of atrial fibrillation was 12.8 +/- 4.8 hours for the amiodarone group compared with 34.7 +/- 28.7 hours for the control group (P = .003). The maximum ventricular rate during atrial fibrillation was slower in the amiodarone group than in the control group (105.9 +/- 19.1 beats per minute and 126.0 +/- 18.5 beats per minute, respectively, P = .016). The two groups had a similar incidence of complication other than rhythm disturbances (20.8% vs 20.0%, P = .904). Amiodarone group patients had shorter hospital stays than that of control group patients (6.8 +/- 1.7 days vs 7.8 +/- 2.9 days, P = .014). The in-hospital mortality was not different between two groups (1.3% vs 3.8, P = .620). Conclusions: Postoperative intravenous amiodarone, followed by oral amiodarone, appears to be effective in the prevention of new-onset postoperative atrial fibrillation. It also reduces ventricular rate and duration of atrial fibrillation after coronary artery bypass grafting. It is well tolerated and decreases the length of hospital stay.
Amiodarone reduces the incidence of atrial fibrillation after coronary artery bypass grafting
(Mosby, Inc, 2003) Yagdi, T; Nalbantgil, S; Ayik, F; Apaydin, A; Islamoglu, F; Posacioglu, H; Calkavur, T; Atay, Y; Buket, S
Objective: The purpose of this study was to evaluate the safety and efficacy of postoperative administration of prophylactic amiodarone in the prevention of new-onset postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. Methods: In this prospective study 157 patients were randomly divided into two groups: 77 patients (amiodarone group) received intravenous amiodarone in a dose of 10 mg/kg/d for postoperative 48 hours. On postoperative day 2 oral amiodarone was started with a dose of 600 mg/d for 5 days, 400 mg/d for the following 5 days, and 200 mg/d for 20 days, and 80 patients received placebo (control group). Results: Preoperative patient characteristics and operative variables were similar in the two groups. Postoperative atrial fibrillation occurred in 8 patients (10.4%) receiving amiodarone and in 20 (25.0%) patients receiving placebo (P = .017). Duration of atrial fibrillation was 12.8 +/- 4.8 hours for the amiodarone group compared with 34.7 +/- 28.7 hours for the control group (P = .003). The maximum ventricular rate during atrial fibrillation was slower in the amiodarone group than in the control group (105.9 +/- 19.1 beats per minute and 126.0 +/- 18.5 beats per minute, respectively, P = .016). The two groups had a similar incidence of complication other than rhythm disturbances (20.8% vs 20.0%, P = .904). Amiodarone group patients had shorter hospital stays than that of control group patients (6.8 +/- 1.7 days vs 7.8 +/- 2.9 days, P = .014). The in-hospital mortality was not different between two groups (1.3% vs 3.8, P = .620). Conclusions: Postoperative intravenous amiodarone, followed by oral amiodarone, appears to be effective in the prevention of new-onset postoperative atrial fibrillation. It also reduces ventricular rate and duration of atrial fibrillation after coronary artery bypass grafting. It is well tolerated and decreases the length of hospital stay.
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, I
The 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.
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, S
Staged 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.
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, S
We 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.
Coronary artery bypass and carotid endarterectomy - Combined approach
(Int Heart Journal Assoc, 2001) Hamulu, A; Yagdi, T; Atay, Y; Buket, S; Calkavur, T; Iyem, H
Controversy exists concerning the best management of patients with coronary, artery and carotid artery disease. Between June 1994 and July 2000, 88 patients with coronary artery and carotid artery disease underwent combined coronary artery surgery and carotid endarterectomy. Demographics and perioperative variables of these patients were compared with those of 266 patients undergoing isolated coronary artery surgery. Patients in the combined coronary artery bypass grafting and carotid endarterectomy group were elderly patients (p=0.0001) with a higher prevalence of female gender (p=0.0001), left ventricular dysfunction (p=0.006), left main coronary artery disease (p=0.033), triple-vessel coronary artery disease (p=0.002), unstable angina pectoris (p=0.004). and history of prior neurologic events (p=0.0001), Three (3.4%) patients in the combined group and 5 (1.9%) patients in the isolated coronary artery surgery group (p=0.317) developed perioperative myocardial infarction. Two (2.3%) patients in the combined group developed a permanent postoperative neurologic event. Hospital mortality was 5.7% (5 patients) in the combined coronary artery bypass grafting and carotid endarterectomy group and 1.5% (4 patients) in the isolated coronary artery, surgery group (p=0.046). Patients with concomitant carotid and coronary artery disease have all advanced arteriosclerosis, Although combined coronary artery bypass grafting and carotid endarterectomy is associated with a higher risk of death and perioperative myocardial infarction thin simple coronary artery surgery, this procedure is a preferable approach for these high-risk patients and results in lower neurologic morbidity.
Dissection of aorta: a pediatric case report
(Turkish J Pediatrics, 2002) Serdaroglu, G; Levent, E; Yurtsever, S; Calkavur, T; Yunten, N; Aydogdu, S
We present a 15-year-old boy who developed sudden walking disability and sensory loss. He could not stand up on his feet and had no feeling following a sudden fall while playing basketball. He had been referred to a local hospital with these symptoms. In his physical examination absence of deep tendon reflexes and sensory loss were noted. His arterial blood pressure was 210/160 mmHg. He was transferred to our hospital with these findings and diagnosis of Guillain-Barre syndrome and hypertensive encephalopathy. There was sudden onset of sensory loss, walking disability and history of trauma. in the following hours hematuria, back pain and lower extremity ischemia developed. We suspected spinal artery injury based on the findings. Dissection of descending aorta was established with the help of magnetic resonance imaging of spinal region and contrasted aortography. The patient went to surgery immediately. He was lost on the second day after operation because of malperfusion. We report this case because dissecting aorta is very rare in the pediatric age group. High index of suspicion and early aortography are needed to diagnose aorta dissection.
The effects of L-carnitine on spinal cord ischemia/reperfusion injury in rabbits
(Georg Thieme Verlag Kg, 2002) Tetik, O; Yagdi, T; Islamoglu, F; Calkavur, T; Posacioglu, H; Atay, Y; Ayik, F; Canpolat, L; Yuksel, M
Background: Paraplegia after distal aortic aneurysm repair remains a persistent clinical problem. We hypothesized that the tolerance of the spinal cord to an ischemic period could be improved with hypothermic Ringer's Lactate containing L-Carnitine. Materials and Methods: Twenty-eight New Zealand white rabbits were used as spinal cord ischemia models. We separated rabbits into four equal groups and clamped each animal's abdominal aorta distal to the left renal artery. We occluded the aortas above the iliac bifurcation for 30 minutes. In group I, the infrarenal aorta was clamped without infusing any solution. In group II, Ringer's Lactate solution was infused at +25degreesC for 3 minutes at a rate of 5 ml/min into the isolated aortic segments immediately after cross-clamping and the last 3 minutes of ischemia. In group III, Ringer's Lactate solution at +3degreesC was given in the same method as that of group II. In group IV, Ringer's Lactate solution at +3degreesC plus 100 mg/kg of L-carnitine was infused using the same technique. We assessed the neurological status of the hind limbs 24 and 48 hours after operation according to Tarlov's criteria. All animals were sacrificed and spinal cords were harvested for histological analyses. Results: The neurological status in groups III and IV was significantly superior to that of groups I and II. All the animals in group I had complete hind-limb paraplegia. Complete hind-limb paraplegia occurred in 5 rabbits in group II. Two of the 7 animals in group III had spastic paraplegia, and none at all in group IV. Histological analysis of the cross-clamped segments of the rabbits with paraplegia in group I, II and III revealed changes consistent with ischemic injury, while findings were normal for the normal animals in group III and IV. Conclusions: In this model, the infusion of hypothermic Ringer's Lactate contained L-carnitine provided sufficient spinal cord protection against ischemia. Clinically, this may be a useful adjunct for prevention of paraplegia during surgery of the descending aorta.
Four years' experience with the Edwards-Tekna bileaflet valve prosthesis
(I C R Publishers, 2002) Calkavur, T; Yagdi, T; Apaydin, A; Islamoglu, F; Posacioglu, H; Durmaz, I; Ozbaran, M
Background and aim of the study: Although over 20,000 Edwards-Duromedics valves were implanted worldwide between 1982 and May 1988, use of the valve was voluntarily suspended by the manufacturer in May 1988 on the basis of reported leaflet escapes. In 1990, a modified version was introduced to the market, the Edwards-Tekna. The study aim was to evaluate the short-term outcome with this revised valve. Methods: Between 1994 and 1998, 137 patients (67 males, 70 females; mean age 36.3 +/- 9.1 years) underwent heart valve replacement with the Edwards-Tekna prosthesis. Among these patients, 72 had isolated mitral valve replacement, 59 isolated aortic valve replacement, and six double-valve replacement. Results: Early hospital mortality was 0.72% (n = 1). Follow up was 95% complete (1291136 patients discharged from hospital). Mean follow up was 24.9 +/- 10.5 months (range: 2 to 48 months); total follow up was 282.9 patient-years (pt-yr). Actuarial freedom from complications at two-year follow up and linearized incidence (%/pt-yr) of these events were: late mortality 87.8 +/- 8.5% (1.77%/pt-yr); thromboembolism 89.8 +/- 4.9% (2.12%/pt-yr); anticoagulation-related bleeding 97.8 +/- 1.5% (0.71%/pt-yr); prosthetic valve endocarditis 99.1 +/- 0.9% (0.35%/pt-yr); valve-related mortality 98.2 +/- 1.2% (0.71%/pt-yr); and valve-related morbidity and mortality 85.0 +/- 5.0% (4.24%/pt-yr). There was no structural valve failure such as leaflet escape in this series. Clinically significant hemolysis was not encountered (mean postoperative plasma LDH level 345 +/- 124 IU/l). Preoperatively, 69% of patients were in NYHA classes III/IV; at two years postoperatively 90% of survivors were in classes I/II. Conclusion: The Edwards-Tekna mechanical valve prosthesis has shown excellent overall clinical performance in the short term, though long-term data are needed to confirm its durability.
An intraaortic solution trial to prevent spinal cord injury in a rabbit model
(W B Saunders Co Ltd, 2001) Tetik, O; Islamoglu, F; Yagdi, T; Atay, Y; Calkavur, T; Ozbek, C; Canpolat, L; Buket, S; Vuksel, M
Objectives: to evaluate the effectiveness of an intraaortic delivered solution on preventing spinal cord injury. Design:forty rabbits were allocated into five equal groups. Materials and Methods: one clamp was placed just distal to the left renal artery, and another was placed just above the iliac bifurcation for 40 min. Group I was not infused (control group). Through a 24G vascular catheter inserted into the isolated aortic segment, 20 nd of LR solution at room temperature (Group 2) 20 ml of LR solution at 3 degreesC (Group 3), and 20 ml of LR solution at 3 degreesC containing 30 mg/kg of methylprednisolone (Group 4) were infused over 3 min. In Group 5, 10mg/kg of vitamins E and C were delivered two days before the experiment, and 20ml of LR solution at 3 degreesC containing 30 mg/kg of methylprednisolone, and 10 mg/kg of vitamins E and C was infused at the operation. Postoperative spinal cord function was assessed using Tarlov's criteria. Results: the neurologic status of Groups 3, 4, and 5 was significantly superior to that of Groups I and 2. No paraplegia was observed in Groups 4 and 5. Spastic paraplegia occurred in all rabbits of Groups I and 2, and in 20% of Group 3. In the electron microscopic evaluation of spinal cord specimens, normal histologic structure was observed in Groups 4 and 5, whereas, some derangements were observed in all others. Conclusions: intraaortic infusion of a hypothermic blended solution containing methylprednisolone, vitamins C and E provided best protection against postischaemic spinal cord dysfunction.
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, F
Background. 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.
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, S
Background: 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.
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, M
Background. 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.
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, S
The 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.
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, C
Background. 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.
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, C
Background. 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.

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