IntroductionOver the years, operability criterias for cardiac surgery has been enhanced. Therefore, averege age of operated patients and co-morbidities have increased. 1) Cerebral injury is one of the most important complications of cardiac surgery which may cause mortality, morbidity, increased hospital costs and impaired quality of life. Perioperative cerebral injury includes stroke that occurs in 1.5% to 5.2% of patients, encephalopathy affecting 8.4% to 32% of patients. 2) Cognitive dysfunction has been reported in approximately 50% of patients at discharge, 36% at 6 weeks, 26%-33% at one year, and 42% at five years. 3,4) Pre-exisiting atherosclerotic plaque, thrombogenesis from the foreign surfaces of cardiopulmonary bypass, air from the cardiopulmonary bypass circuit, and pericardial fat globules are tought to be primary predictors of cognitive decline by creating microemboli during Purpose: The purpose of this study was to research the use of near-infrared spectroscopy (NIRS) on the neurocognitive functions in the patients undergoing coronary artery bypass grafting (CABG) with asymptomatic carotid artery disease. Methods: The study design was carried out with the participation of 79 patients in a prospective, randomized and double blind control method. The patients were separated into two groups as NIRS (n = 43) and no NIRS (n = 36). A neurocognitive test was applied preoperatively and postoperatively to all patients before discharge. Cognitive functions were evaluated by applying the Montreal Cognitive Assessment test (MoCA). Results: The decrease in the postoperative score of mean MoCA in no NIRS group was statistically significant when compared to preoperatively (p <0.001). Postoperative mean MoCA score was found to be significantly higher in NIRS group (NIRS: 26.8 ± 1.9 vs. no NIRS: 23.6 ± 2.5, p <0.001). It has been determined that there was a moderately positive significant correlation between the increase in the NIRS used patients (%) and increase in the MoCA score of the patients (r = 0.59, p <0.001). Conclusion: Intraoperative NIRS usage in the patients undergoing CABG with carotid artery disease might be useful due to its postoperative positive effects on the cognitive functions.

No abstract

Hypercholesterolemia is related to increased risk of aortic valve calcification in patients with degenerative and congenital etiology. Preventive treatment of hypercholesterolemia could play an important role to decrease or inhibit development of aortic valve calcification.

We analyzed cases of re-exploration for bleeding after 19,680 open heart operations performed between January 1995 and January 2009 to determine the risk factors for mortality and morbidity. Half of the 282 patients reexplored had nonsurgical causes of bleeding. The patients were grouped according to the timing of reoperation, early re-exploration being on the day of the operation. Mortality, total morbidity, and the need for transfusion of any blood product were compared between the early and late re-exploration groups. Most patients (77.7%) were reexplored early. Overall mortality was 8.5% (24 patients). Mortality, total morbidity, renal, gastrointestinal, neurologic and infectious complications, and low cardiac output differed significantly between the 2 groups. Significant predictors of mortality were old age, female sex, left ventricular dysfunction, noncoronary operations, and delayed reoperation. Predictors of morbidity were old age, preoperative dialysis, tobacco use, chronic lung disease, and delayed reoperation. No factors were found to be associated with the need for transfusion.

The COVID-19 pandemic has presented a great challenge for the healthcare systems and healthcare workers worldwide. The resources and the infrastructure of the healthcare systems are reorganized to provide care for abundant number of pandemic patients. All elective procedures and treatments have either cancelled or postponed. Treatment of lower extremity ulcers may be misclassified as non-essential during this pandemic; however, without regular best wound care, these ulcers are at a great risk of becoming quickly infected, which may lead to an increased rate of septicemia, amputations, and even deaths in this fragile patient population. In this review, we discuss the treatment strategies for lower leg ulcers and vascular pathologies during pandemic and provide an algorithm for triage which may be a useful guide for vascular surgeons.