Which Offers the Best? Stent Graft or Bare Metal Stent for Endovascular Treatment of Aortoiliac Disease

Background: In the present study, it was aimed to compare the stent grafts and bare-metal stents in terms of post-procedural patency, clinical recovery and complications in the subjects with symptomatic aorto-iliac arterial disease. Methods: A total of 79 subjects with symptomatic aorto-iliac arterial disease treated with endovascular methods were included in the present study. Forty three subjects received self-expendable bare metal stent (ev3 Protégé stent system, Endovascular Inc., Plymouth, Minnesota, USA) and 36 subjects received PTFE-covered stent graft (Fluency Plus Stent Graft, Bard Peripheral Vascular, Tempe, Arizona). The subjects were compared after and at Months 1, 6, and 12 following the procedure in terms of Rutherford’s classification, ankle-arm index (AAI), patency rates, and complications. Results: The subjects receiving bare metal stent and stent graft for aorto-iliac arterial disease were followed for averagely 15 months. For the subjects receiving bare metal stent, primary patency rates at months 1, 6, and 12 were 98%, 81%, and 70%, respectively, while secondary patency rate at month 12 was found to be 84%. For the group of stent graft, primary patency rates were found as 97%, 97%, and 92%, respectively and secondary patency rate at month 12 was found to be 94%. Stent grafts were applied at the same time in 2 patients who had metal bare metal because the rupture occurred during the procedure. In the comparison between two groups, the group of stent graft was found to be statistically superior to the other in terms of patency, clinical and post-procedural complications. Conclusion: In conclusion, it was found that the stent grafts were superior to the bare metal stents in terms of patency and complication rates in the subjects with symptomatic aortoiliac disease.

Surgical Results of Left Ventricular Lead Implantation for Cardiac Resynchronization Therapy

Objectives: Cardiac resynchronisation therapy (CRT) has proven its effectiveness in patients with symptomatic heart failure [1,2]. Although rewarding, the procedure of biventricular pacemaker implantation is challenging and subsequently fails in 8%-11% of patients. In patients whose left ventricular (LV) electrode cannot be placed transvenously, surgical implantation of an epicardial electrode can be achieved. Methods: Seventeen patients (14 male, 3 female), among whom LV electrode was failed to be placed transvenously, were included into our study. The epicardial LV electrodes were implanted through anterior mini thoracotomy. The patients were followed up for approximate six months and complications, ejection fraction (EF), New York Heart Association (NYHA) class, QRS durations as well as pacing parameters were recorded. Results: Mean age of the patients was 64.4 ± 7.01 (54-79) years. Preoperative mean EF of the patients was 26.1% ± 3.7%. The LV electrode was placed at the optimal place on the lateral LV wall through left sided mini thoracotomy. The mean duration of the operation was 26.76 ± 8.12 minutes and the mean hospital stay was 2.05 ± 0.42 days. There were no intraoperative or postoperative complications. Only 1 patient had LV electrode displaced on the 3rd postoperative month and the patient was reoperated successfully. The EF on the 6th postoperative month was 29.4% ± 3.81% and NYHA class was 2.58 ± 0.5. The etiology of heart failure had no influence on outcome. Conclusions: Surgical implantation of LV lead is associated with low complication rates and excellent follow-up results without exposure to radiation. Thus epicardial leads can be proposed as equal alternative to transvenous leads.

Levosimendan usage in patients with left ventricle dysfunction in coronary artery bypass graft surgery

Introduction: In this study we explicated early results of patients (the patients in whom levosimendan was used) who underwent coronary artery bypass graft surgery with ejection fraction 35% or less. We compared this group with the patients in whom levo-simendan was not used. Material and Methods: 97 patients who have 35% ejection fraction or less taken to isolated coronary artery bypass surgery between January 2009 and December 2011 in our clinic are chosen for this study retrospectively. We compared the patients in whom levosimendan was used with the patients in whom levosimendan was not used. Levo- simendan (Simdax, Abbott) has been used according to surgeon’s decision in patients. Results: The mean age of group 1 was 62.3 ± 7.6, and the mean age of group 2 was 59.3 ± 10.5 (p > 0.05). It was detected that the average ejection fraction was less in group 1 (p 0.05). It was found that need for blood transfusion were less in group 1 than group 2 (p 0.05). Conclusion: We consider levosimendan reduces need for blood transfusion in coronary artery bypass graft surgery. This results may change with increasing number of patients so we consider that multicenter larger study is needed.

Is coronary artery bypass surgery riskier in female?

Introduction: In this study we examined the early results of coronary artery bypass surgery in our female patients and compared them with those of our male patients. Material and Methods: One thousand and ninety four patients who underwent coronary artery bypass surgery between January 2009 and December 2011 inour clinic were included into this study. Three hundred and thirteen female patients (group 1) were compared to 781 male patients (group 2). Results: The mean age of group 1 was 61.4 ± 9.6, and the mean age of group 2 was 58.1 ± 9.6 (p < 0.001). The ratio of diabetes mellitus and hypertension in group 1 was higher than that of group 2 (p < 0.001). There were no significant difference between two groups when compared regarding the need for inotropics after weaning from cardiopulmonary bypass, cross clamp and total cardiopulmonary bypass periods (p > 0.05). It was found that the amount of drainage was higher in group 1 than group 2 (p < 0.001). There was no significant difference between two groups when compared in terms of mortality, re-operation (because of bleeding), postoperative atrial fibrillation, need for intraaortic balloon pump, usage of levosimendan, cerebrovascular accident, chronic renal failure, discharging intervals and period in intensive care unit. It was found that sternal wound infection was higher in group 1 than group 2 (p < 0.05). Conclusion: We consider that female gender does not put an additional risk to increase mortality and morbidity in coronary artery bypass surgery.

The Role of Chlamydia pneumoniae in the Atherosclerotic Process of Patients under 50 Years of Age Who Underwent Coronary Artery Bypass Graft Surgery

Background: To evaluate the presence of C. pneumoniae DNA in the tissues and C. pneumoniae DNA antibodies in the blood samples of patients who underwent CABG surgery. Material and Methods: Fifty-one patients aorta. C. pneumoniae DNA was evaluated in the tissues collected from the atrium, left internal thoracic artery and ascending aorta of patients. Results: Although, C. pneumoniae DNA was negative in the atrial and left internal thoracic artery tissues of all patients, it was positive in the tissues obtained from the ascending aortas of twelve patients. C. pneumoniae DNA positivity was significantly higher in patients with increased aortic intimal thickness compared to those without increased aortic thickness. Conclusion: The question whether C. pneumoniae is triggering atherosclerosis or is involved as a super-infection could not be clarified.