BackgroundThe aim of this study was to compare the effects of single-clamping and partial-clamping techniques on postoperative stroke during coronary artery bypass surgery.MethodsBetween December 2008 and December 2012, 2 000 patients who underwent coronary artery bypass grafting in two hospitals were analysed. Post-operative neurological complications were analysed retrospectively in these patients. The cases were divided into two groups: in group 1, 1 500 patients were analysed, in whom proximal anastomosis was performed with partial clamping in a beating heart (n = 1 500, 846 male, 654 female; mean age 63.25 ± 5.72 years; range 43–78 years). In group 2, 500 patients were analysed, in whom proximal anastomosis had been performed by other surgical teams in another hospital, with cross clamping in a resting heart with cardioplegia (n = 500, 296 male, 214 female; mean age 64.83 ± 8.12 years; range 41–81 years). During 30 days post-operatively, neurological deficits, stroke incidence and the relationship of the clinical situation to mortality were analysed.ResultsFor both groups, patients were similar in terms of patient characteristics. In group 2, cross-clamp duration and perfusion time were longer; however, time of hospital stay was similar in the two groups. Post-operative stroke was seen in 26 patients in group 1 (1.73%) and in nine in group 2 (1.8%). The difference between the two groups was not statistically significant (p = 0.92). All stroke patients were over the age of 55 years. Seven of the stroke patients died (21.1%). In total, 31 patients died because of multiple organ failure in the postoperative 30 days (group 1: 1.6%; group 2: 1.4%) (p = 0.91). Smoking, diabetes mellitus, hypertension, atrial fibrillation, peripheral vascular disease and hypercholesterolaemia were found to be factors that affected stroke development. Mean duration of hospital stay was 5.1 ± 2.8 days in group 1 and 4.9 ± 3.6 days in group 2 and the difference between the two groups was not statistically significant (p = 0.46).ConclusionIn patients without plaques in the aorta, performing partial clamping did not increase stroke incidence.

PurposeThe aim of this study was to evaluate whether poor oral hygiene is associated with carotid and popliteal arterial intima–media thickness, which is one of the predictors of future progression of sub-clinical atherosclerosis, and high-sensitivity C-reactive protein (hsCRP) and fibrinogen levels.MethodsA specialised dentist checked the patients and selected 550 patients during periodontal examinations, according to their oral hygiene. The patients had no history of atherosclerotic disease. Carotid and popliteal artery B-mode ultrasonographic examinations and hsCRP and fibrinogen levels were analysed at baseline and after a mean of 6.2 months. The patients were scored on the DMFT index for the number of decayed (D), missing (M), and filled (F) teeth (T). We also used the Silness-Loe plaque index (SLI) to evaluate oral hygiene and dental plaque. The patients were divided into two groups using the DMFT and SLI criteria. Group I had a DMFT index score from 0 to 3 and SLI index score of 0 or 1. Group II had a DMFT index score from 4 to 28 and SLI index score of 2 or 3.ResultsA significant association was observed between dental status, oral hygiene, carotid and popliteal artery intima–media thickness and hsCRP level. Patients with increasing DMFT and SLI scores correlated with increasing carotid artery intima–media thickness.ConclusionsThe results clearly showed that chronic poor oral hygiene and tooth loss are related to sub-clinical atherosclerotic changes in the carotid arteries and may be indicative of future progression of atherosclerosis.

Coronary artery bypass grafting can be safely performed in patients with low ejection fraction with minimal postoperative morbidity and mortality. The viable myocardium could be reliably determined by positron emission tomography. Low ejection fraction patients could greatly benefit from coronary bypass surgery regarding postoperative ejection fraction, increased long-term survival, improvement in New York Heart Association classification, and higher quality of life.

No abstract

A AB BS ST TR RA AC CT T OOb bj je ec ct ti iv ve e: : The aim of this study was to assess the efficacy and side effects of postoperative administration of amiodarone as a prophylaxis for or treatment of new onset atrial fibrillation after coronary artery bypass grafting surgery. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Between January 2010 and January 2012, we conducted a retrospective analysis on consecutive patients who underwent coronary artery bypass grafting surgery. Patients were grouped according to whether they received amiodarone for prophylaxis or for treatment of atrial fibrillation. In Group 1, amiodarone was given after new onset atrial fibrillation for treatment (Group 1; n=595; 378 males, 217 females; mean age 62.16±4.72 years; range 43-78 years). Group 2 received amiodarone for prevention of postoperative atrial fibrillation (Group 2; n=500; 344 males, 156 females; mean age 61.43±6.12 years; range 41-81 years). The patients were followed-up for arrhythmias and left ventricular function using electrocardiography and echocardiography. R Re es su ul lt ts s: : Preoperative patient characteristics and operative variables were similar in two groups. Patient recovery was significantly slower in Group 1. Postoperative atrial fibrillation occurred in 595 patients among 3500 patients (17%) who underwent coronary bypass surgery without amiodarone, and in 27 patients (5.40 %) receiving amiodarone as prophylaxis (p=0.0001). Mean pulmonary and liver function tests were not significantly different between two groups. Group 2 patients had shorter hospital stays compared to Group 1 patients (Group 2: 4.9+3.6 days vs. Group 1: 6.2+5.8 days, p=0.001). The in-hospital mortality was not different between the two groups (1.5% vs. 1.2%, p=0.176, respectively). C Co on nc cl lu us si io on n: : Postoperative prophylactic amiodarone therapy in patients undergoing coronary bypass surgery is well tolerated and significantly reduces the incidence of postoperative atrial arrhythmias while not affecting left ventricular function. K Ke ey y W Wo or rd ds s: : Coronary artery bypass; amiodaron; prevention and control Ö ÖZ ZE ET T A Am ma aç ç: : Bu çalışmanın amacı, koroner arter baypas operasyonlarından sonra başlayan atriyal fibrilasyonda, amiodaronun tedavi amaçlı veya proflaktik amaçlı kullanımının etkinlik ve yan etkilerini değerlendirmektir. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Ocak 2010 ile Ocak 2012 tarihleri arasında ardışık olarak koroner arter baypas cerrahisi uygulanan hastaların verileri geriye dönük olarak değerlendirildi. Hastalar atriyal fibrilasyonun tedavisi veya proflaktik amaçlı amiodaron kullanımına göre iki gruba ayrıldı. Yeni başlayan atriyal fibrilasyonun tedavisi amacıyla amiodaron uygulanan hastalardan elde edilen veriler Grup 1 içinde değerlendirildi (Grup 1; n=595; 378 erkek, 217 kadın; ortalama yaş 62,16±4,72 yıl; dağılım 43-78 yıl). Atriyal fibrilasyon gelişmeden proflaktik olarak amiodaron verilen hastalardan elde edilen veriler de Grup 2 içinde değerlendirild...