Giriş: Biz kırmızı küre dağılım hacmi (RDW)'nin koroner arter hastalarında cerrahi revaskülarizasyon sonrası sonuçlarda belirleyici olduğunu düşündük. Gereç ve Yöntem: Ciddi koroner arter hastalığı olan koroner baypas cerrahisi geçirmiş 94 hasta çalışmaya dahil edildi. Toplam 94 hasta RDW değerlerine göre üç gruba ayrıldı (mean RDW: tertile 1, 12.68 ± 0.60; tertile 2: 13.64 ± 0.49; tertile 3, 16.47 ± 2.04). Bulgular: Ortalama 51 aylık takipte toplam 18 (%19.1) ölüm gözlendi. Yüksek RDW'li hastalar orta (%10) ve düşük (%13) RDW'li hastalara kıyasla yüksek mortalite gösterdi. Değişkenli regresyon analizinde RDW > 14.6 beş yıllık sonuçlar için önemli bağımsız risk faktörüdür. Sonuç: Sonuç olarak, koroner baypas cerrahisi geçirmiş hastaların preoperatif yüksek RDW değeri artmış uzun dönem mortalite riski ile ilişkilidir.
A consensus has not yet been reached regarding which COVID-19 vaccine program should be applied in patients with ventricular assist device (VAD). Our aim was to assess the clinical outcome of inactivated, mRNA and heterologous vaccine program in patient with VAD.In this retrospective and cross-sectional study; adult patients who underwent VAD implantation between January 2012 and September 2021 and received any vaccine that were used in Republic of Türkiye for COVID-19, were included. The patients were divided into three groups according to the type of vaccine; "inactivated," "mRNA" and "heterologous." Clinical outcomes were analyzed.Eighteen patients were in each group in the "inactivated," "mRNA" and "heterologous" groups. Mean age was 51.6 ± 12 years in "inactivated" group, 42.5 ± 15.5 years in "mRNA" group and 41.1 ± 15.4 years in "heterologous" group. There was no significant difference between the groups in age, gender, body surface area, body mass index and etiology (p > 0.05). After last dose of vaccines, the number of patients had COVID-19 positive test were three (16.7%), one (5.6%), and two (11.1%) in "inactivated," "mRNA" and "heterologous" groups, respectively. Pump thrombosis was seen in two patients in "mRNA" group and one patient in "heterologous" group. No pump thrombosis was seen in "inactivated" group. COVID-19-related death or intubation was not observed.All vaccine that used for COVID-19 are safe and effective in patients with VAD. In countries that give priority to inactivated vaccines, mRNA vaccines may then be made as boosters.
This study aims to investigate the effects of reoperative sternotomy on early and long-term outcomes after heart transplantation.We retrospectively reviewed data of a total of 92 patients (72 males, 20 females; mean age 36 years; range, 3 to 61 years) who underwent orthotopic heart transplantation between May 1998 and July 2014. The patients were divided into three groups. Group A (n=23) included patients who underwent previous cardiac surgery with sternotomy other than ventricular assist device implantation; Group B (n=12) included patients who were bridged-to-transplant with a ventricular assist device; and Group C (n=57) included patients who for the first time underwent heart transplantation without previous sternotomy. Preoperative and operative data of the three groups were compared. The short- and long-term outcomes of all groups were analyzed.There was no significant difference among the groups, except for the age and preoperative international normalized ratio. Total ischemia time in the ventricular assist device group was longer than Group C. The length of intensive care unit stay was also longer in the ventricular assist device group than the other groups. The amount of postoperative chest tube drainage and blood transfusion was higher in Group A. Early mortality rate was significantly higher in Group A. There was no significant difference in survival among the three groups in the long-term. According to the logistic regression analysis, no variable was found to be a significant risk factor for mortality.Reoperative sternotomy other than ventricular assist device implantation was found to be a risk factor for early mortality; however, mid and long-term survival rates were similar to patients in whom transplantation was the primary procedure. In patients with reoperative sternotomy, heart transplantation can be performed with similar risks to patients without resternotomy with careful selection and accurate pre- and intraoperative surgical approach.
Left ventricular assist device implantation through left thoracotomy with outflow anastomosis to the descending aorta is an uncommon approach, particularly in patients with previous sternotomies. However, this approach has certain advantages, such as better surgical outcomes and lower complication rates. Here, we report the technique adapted for HeartMate 3 implantation through left thoracotomy with descending aortic anastomosis.
