Objective: The aim of this study was to evaluate the relation between blood gamma-glutamyltransferase (GGT) levels and coronary collateral circulation in patients with chronic total occlusion (CTO). Methods: Two hundred twenty-two patients with chronic stable coronary artery disease (CAD) and CTO were included in this cross-sectional, observational study. Coronary collaterals were graded from 0 to 3 according to the Rentrop method. Patients with grade 0-1 collateral development were regarded as poor collateral group (n=66) while patients with grade 2-3 collateral development were regarded as good collateral group (n=156). Statistical analysis was performed using independent samples t, Mann-Whitney U and Chi-square tests, logistic regression and receiver operator curve analysis. Results: The poor coronary collateral group had significantly higher levels of serum GGT compared to the good collateral group (p<0.001). Multiple logistic regression analysis showed that GGT levels were independent predictors of poor collateral circulation (OR-0.946, 95% CI=0.918-0.9719, p<0.001). The result of ROC curve analysis for GGT was as following: area under the ROC curve (AUC)=0.732, 95% CI: 0.622-0.841, p<0.001. Conclusion: Higher GGT levels are associated with poor coronary collateral circulation in patients with CTO. GGT may be used to predict the grade of coronary collateral circulation in CTO patients with chronic stable CAD. (Anadolu Kardiyol Derg 2014; 14: 48-54)

SummaryIntroduction:Coronary artery bypass grafting (CABG) results in higher morbidity and mortality rates in end-stage renal disease (ESRD) patient populations than in patients with normal renal function. This study aimed to identify the early results of CABG performed on ESRD patients, and the factors that affected the mortality rates of those patients.Methods:A retrospective evaluation of our hospital database revealed 84 haemodialysis-receiving patients who underwent CABG during the years 2006 to 2012. Mortality was observed in 21 patients (group 1), and this group was compared with the remaining patients (group 2) for peri-operative parameters such as age, EuroSCORE, functional capacity, myocardial infarction, use of inotropes and completeness of revascularisation.Results:The study included 60 male (71.4%) and 24 female patients (28.6%); the participants’ mean age was 59.50 ± 9.93 years. The pre-operative additive EuroSCORE was 7.96 ± 2.88 (range: 2–18). Pre-operative functional capacity was impaired in 35.7% of the patients [New York Heart Association (NYHA) classes III–IV]. Mean age and preoperative EuroSCORE values of group 1 were significantly higher than those of group 2. Impaired functional capacity (NHYA classes III–IV) was also associated with mortality (OR: 3.333; 95% CI: 1.199–9.268).Fifty-four patients (64.3%) underwent on-pump CABG procedures, and 30 (35.7%) underwent off-pump CABG procedures. The study found no statistically significant difference in mortality rates between these two techniques. Mortality occurred in 12 patients (22.2%) in the on-pump group and in nine (30%) in the off-pump group. Complete revascularisation was performed on 46 patients (85.2%) in the on-pump group and seven (23.3%) in the off-pump group (p < 0.001).ConclusionAdvanced age, impaired NYHA functional capacity and pre-operative hypertension were determinative for early-term surgical mortality. An on-pump surgical technique is recommended to ensure completeness of revascularisation.

Objective To evaluate the frequency, causes, and related predictive factors of intensive care unit (ICU) readmissions after coronary artery bypass grafting (CABG) surgery. Methods A total of 4112 consecutive patients who underwent on-pump CABG between January 2007 and January 2017 were retrospectively evaluated. The patients were divided into two groups as patients with and without ICU readmission. Demographic and perioperative characteristics were compared between the two groups. Results The ICU readmission rate was 3.5%. The most common reasons for ICU readmissions were respiratory (29%) and cardiac (23.4%) complications. The 90-day mortality risk was significantly higher in the readmitted patients than the non-readmitted patients (22.1% and 1.6%, respectively; P <0.001; OR=17.6; 95% CI=11.19-28.41). Severe left ventricular dysfunction, chronic obstructive pulmonary disease, end-stage renal disease, emergency CABG, EuroSCORE II > 5%, cross-clamp time > 35 minutes, postoperative respiratory complications, neurological complications, and cardiac complications showed a strong association with ICU readmissions. Conclusion ICU readmission after CABG is associated with an increased mortality rate. Evaluation, not only of patients’ comorbidities, but also of intraoperative conditions and postoperative complications, is important to identify patients at risk for ICU readmission.

Coronary subclavian steal syndrome refers to decreased or reversed internal mammary artery flow, which causes angina related to severe subclavian steno-occlusive disease in patients with in situ internal mammary-to-coronary artery graft. We present a 48-year-old man with cerebrovascular and peripheral artery disease and the first case in the literature of a saphenous vein graft-coronary-subclavian unidirectional steal syndrome.

Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmamızda, reoperatif koroner baypas cerrahisinde hastane mortalitesini etkileyen risk faktörlerini araştırmayı amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Kliniğimizde, 1998'den 2010'a kadar izole reoperatif koroner baypas geçiren 105 hasta (ortalama yaş 58,6±8,8 yıl, yaş aralığı 19-79), retrospektif kohort bir çalışma dizaynı ile incelendi. Reoperatif koroner baypas ile birlikte eş zamanlı prosedür uygulanan hastalar çalışma dışı bırakıldı. Ameliyat öncesi, ameliyata ait ve ameliyat sonrası değişkenler kullanılarak hastane mortalitesine neden olan risk faktörleri araştırıldı. Hastane mortalitesinin bağımsız risk faktörleri lojistik regresyon analizi ile belirlendi. B Bu ul lg gu ul la ar r: : Hastane mortalitesi %12,3 (13 hasta) olarak bulundu. Hastalarımızın %37,1 'i 1998-2004 arasında ve %62,9'u 2005-2010 arasında reopere edildi. İki ameliyat arasında geçen süre 1 yıl ile 20 yıl arasında değişmekte olup, ortalaması 7,80±5,38 yıl idi. Tek değişkenli analizde mortalitenin risk faktörleri; ilk ameliyatta internal mamarian arterin kullanılmaması, inkomplet revaskülarizasyon, Kanada Kardiyovasküler Derneği sınıf 3 yada 4 ağrı, ileri sol ventrikül disfonksiyonu, düşük kalp debisi, iki ameliyat arasındaki sürenin10 yıl ve üzeri olması, kanama veya greft tıkanıklığı nedeniyle revizyon ve uzamış entübasyon olarak saptandı. Lojistik regresyon analiz ile mortalitenin bağımsız risk faktörleri; düşük kalp debisi, iki ameliyat arasındaki sürenin 10 yıl ve üzeri olması ve uzamış entübasyon olarak bulundu. S So on nu uç ç: : Risk profilinin belirlenmesi ve hasta seçimi, hastane mortalitesinin düşürülmesi için ilk adım olabilir. Yüksek risk profilindeki olgularda, off-pump teknik ile revaskülarizasyon, hibrid revaskülarizasyon veya optimal medikal tedavi gibi farklı tedavi alternatiflerinin de değerlendirilmesi düşünülebilir.A An na ah ht ta ar r K Ke el li im me el le er r: : Reoperasyon; kalp debisi, düşük; koroner arter baypas; hastanede ölüm oranı A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : In our study, we aimed to investigate the risk factors for hospital mortality in reoperative coronary bypass surgery. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : In our clinic, 105 (mean age 58.6±8.8 years, age range 19-79) patients who underwent isolated reoperative coronary artery bypass grafting between 1998 and 2010 were examined using a retrospective cohort study design. Patients who had concomitant procedures were excluded from the study. The risk factors that caused hospital mortality were investigated by using the preoperative, operative and postoperative variables. Independent risk factors for hospital mortality were determined by logistic regression analysis. R Re es su ul lt ts s: : Hospital mortality was found as 12.3% (13 patients). Thirty-seven percent of patients were operated on between 1998 and 2004, and 62.9% between 2005 and 2010. The average time between two operations was 7.80 ± 5.38 years, ranged between 1 and 20 years. Univariate ...