In isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay, and lesser pain in the early postoperative period in contrast to conventional surgery. The result of our studies, which showed similarities to the past studies, lead us to recognize the importance of minimally invasive interventions and the need to perform them more frequently in the future.

BackgroundMedian sternotomy provides excellent access to all mediastinal structures in patients undergoing conventional cardiovascular surgery. Although this incision technique is associated with relatively lower complication rates, certain complications such as the sternal dehiscence may pose serious health consequences. In this regard, considerable effort has been paid to develop techniques aiming to improve sternal healing and to enhance postoperative recovery after conventional cardiac surgery. Among these, kryptonite bone cement, a biocompatible polymer with improved mechanical properties when combined with a standard wire cerclage, represents a promising novel approach that may help prevent sternal dehiscence. In this study, the effects of this particular type of bone cement on sternal healing, postoperative pain, and quality of life have been evaluated.MethodsKryptonite bone cement enhanced sternal closure was employed in a total of 100 patients undergoing conventional cardiac surgery between November 2009 and June 2012. Of these patients, 50 expressed their willingness to participate in this study. Each participant underwent a computerized tomography imaging for the radiological assessment of sternal healing. Pain and life quality of these patients have been evaluated by Wong-Baker faces pain scale and SF-36 health survey questionnaire, respectively.ResultsMean duration of follow-up was 20.14 ± 7.36 months (range: 10–32). Mean age and body mass index were 71.32 ± 7.23 years (range: 55–85) and 28.34 ± 2.62 (21–34) kg/m2, respectively. Elderly patients (≥70), females and those with chronic obstructive pulmonary disease (COPD) comprised 64%, 26% and 40% of the study population, respectively. No patients had findings suggestive of dehiscence on CT images. No patients reported severe pain (i.e. all patients had a Wong-Baker faces pain scale score <4). Elderly (≥ 70 yr) subjects had better quality of life scores as compared to the remaining group of patients (< 70 yr) according to SF-36 Health Survey results. Vitality and emotional role scores were lower (63.5 ± 25.5, p = 0.018 and 41.7 ± 23.3, p = 0.001, respectively) in female patients. Patients with COPD had lower quality of life scores than those without COPD, particularly with respect to general health scores (73.3 ± 18.5; p = 0.012).ConclusionsKryptonite bone cement, when combined with a standard wire cerclage, enhances mechanical strength, prevents sternal dehiscence, reduces postoperative pain and improves quality of life after conventional cardiac surgery. Long-term studies are warranted to better define the role of kryptonite bone cement in the prevention of sternal dehiscence.

In contrast to medical therapy in the treatment of deep vein thrombosis, usage of catheter-directed thrombolysis experienced early recanalization with higher thrombus resolution. PMT with adjunctive thrombolytic therapy is an effective treatment modality in patients with significant DVT. Also, early thrombus removal in patients with acute DVT prevents development of postthrombotic morbidity. We believe that the efficacy and usage will increase with the experience of surgeons in the future.

IntroductionVarious surgical procedures for minimally invasive cardiac surgery have been described in recent decades as alternatives to median sternotomy. Cardiopulmonary bypass via femoral arterial and venous cannulation is the foundation of these procedures. In this study, we evaluated the mid-term outcomes of femoral cannulation performed with U-suture technique in patients undergoing robotic heart surgery.MethodsA total of 216 patients underwent robotic-assisted cardiac surgery between January 2013 and April 2017. Cardiopulmonary bypass was performed via femoral artery, jugular, and femoral vein cannulation, and a Chitwood clamp was used for aortic occlusion. A total of 192 patients attended the outpatient follow-up, and femoral arterial and venous flow pattern was examined using Doppler ultrasound (DUS) in 145 patients.ResultsHospital mortality occured in 4 of the 216 (1.85%) cases, but there was no late mortality in this patient group. Postoperatively, seroma (n=9, 4.69%) and cannulation site infection (n=3, 1.56%) were managed with outpatient treatment. DUS in 145 patients revealed triphasic flow pattern in the common femoral arteries in all patients except for 2 (1.38%). These patients were determined to have asymptomatic arterial stenosis. Chronic recanalized thrombus in the common femoral vein was also detected in 2 (1.38%) patients.ConclusionFemoral artery cannulation with the U-suture technique can be successfully performed in robotic-assisted cardiac surgery, with good mid-term results.

Objectives Malnutrition has been shown to be associated with survival in a variety of diseases. Our aim is to evaluate the prognostic value of objective nutritional indexes indicating malnutrition, in patients underwent endovascular aortic replacement. Methods We retrospectively evaluated 149 consecutive patients who underwent technically successful endovascular aortic replacement operation between October 2010 and August 2019. Objective nutritional indexes, prognostic nutritional index, geriatric nutritional risk index and controlling nutritional status, scores were calculated using the preoperative data. Optimal cut-off values were obtained by receiver operating characteristic analysis. According to the cut-off values, we investigated the relationship between indexes and the long-term all-cause mortality. Results During mean 48.0 ± 30.3 months follow-up duration, in 47 of patients (31.5%), all-cause mortality were documented. In mortality group, prognostic nutritional index (42.8 ± 7.1 vs 51.3 ± 5.2, p < 0.001) and geriatric nutritional risk index (100.7 ± 10.1 vs 107.6 ± 9.2, p < 0.001) were significantly lower, controlling nutritional status score (2.0 (1.0–4.0) vs 1.0 (0.0–2.0), p < 0.001) was higher when compared to survivor group. Kaplan–Meier curves presented higher mortality incidence in malnutrition patients evaluated with objective nutritional indexes (Log-rang test, for all three indexes p < 0.001). Besides Cox-proportional hazard analysis showed all three nutritional indexes may be a predictive marker for all-cause mortality, prognostic nutritional index introduced more valuable data than other two indexes. Conclusions Malnutrition is associated with significant increase in postoperative long-term mortality in endovascular aortic replacement patients. Preoperatively calculated objective nutritional indexes especially prognostic nutritional index can be used as an important prognostic tool.