ABSTRACT Introduction: In this study, sternal complication rates of sternal closures with steel wire or steel wire combined with titanium plate in patients with obesity that underwent cardiac surgery were investigated. Methods: The data of 316 patients that underwent cardiac surgery between May 2018 and October 2021 were analyzed retrospectively; 124 patients withbody mass index (BMI) ≥ 30 kg/m2 were divided into group I, patients whose sternotomy was performed with steel wires, and group II, patients whose sternotomy was performed with steel wire combined with titanium plates. Results: A total of 124 patients with BMI ≥ 30 kg/m2 were divided into group I (n=88 [70.9%]) and group II (n=36 [29.1%]). The rate of male patients was found to be significantly higher in group I, whereas the rate of female patients was significantly higher in group II (P<0.001). BMI values were found to be low in group I and high in group II (P<0.001). The distribution of complications was different in the BMI ≥ 35.00-39.99 kg/m2 and ≥ 40 kg/m2 groups (P=0.003). Development of complications was found to be higher in patients with BMI ≥ 40 kg/m2. Sternal dehiscence was observed in two patients in group I, while no dehiscence was observed in group II. Conclusion: The lower incidence of complications and the absence of non-infectious sternal complications and sternal dehiscence in patients with BMI ≥ 35 kg/m2 that underwent steel wire combined titanium plate sternal closure strengthened the idea that plate-supported sternal closure can prevent sternal complications in high-risk patients.

ABSTRACT Introduction: In this study, sternal complication rates of sternal closures with steel wire or steel wire combined with titanium plate in patients with obesity that underwent cardiac surgery were investigated. Methods: The data of 316 patients that underwent cardiac surgery between May 2018 and October 2021 were analyzed retrospectively; 124 patients withbody mass index (BMI) ≥ 30 kg/m2 were divided into group I, patients whose sternotomy was performed with steel wires, and group II, patients whose sternotomy was performed with steel wire combined with titanium plates. Results: A total of 124 patients with BMI ≥ 30 kg/m2 were divided into group I (n=88 [70.9%]) and group II (n=36 [29.1%]). The rate of male patients was found to be significantly higher in group I, whereas the rate of female patients was significantly higher in group II (P<0.001). BMI values were found to be low in group I and high in group II (P<0.001). The distribution of complications was different in the BMI ≥ 35.00-39.99 kg/m2 and ≥ 40 kg/m2 groups (P=0.003). Development of complications was found to be higher in patients with BMI ≥ 40 kg/m2. Sternal dehiscence was observed in two patients in group I, while no dehiscence was observed in group II. Conclusion: The lower incidence of complications and the absence of non-infectious sternal complications and sternal dehiscence in patients with BMI ≥ 35 kg/m2 that underwent steel wire combined titanium plate sternal closure strengthened the idea that plate-supported sternal closure can prevent sternal complications in high-risk patients.

Abstract Peripheral arterial disease is a serious clinical manifestation caused by atherosclerosis. It is one common cause of morbidity and mortality worldwide. It is commonly seen in males, and its (prevelance) increases with age. It is most prevalent with smoking, hypertension, diabetes mellitus and hyperlipidemia. Novel studies investigate the relationship between triglyceride-glucose index (TyG) and cardiovascular diseases. Studies investigating the association of this index and peripheral arterial disease and disease severity are generally done by using The Trans-Atlantic Inter-Society Consensus (TASC) classification. We aimed to study this association by using the new Global Limb Anatomic Staging System (GLASS) classification. Two hundred patients between 25 to 90 years old diagnosed with peripheral arterial disease and admitted to the hospital for peripheral arterial angiography between July 2021 and December 2021, were evaluated retrospectively with blood parameters and angiographic images. Patients were divided into two groups: moderate (group 1; n=58) and severe (group 2; n=142) according to the GLASS classification. No statistical differences were observed for comorbidities and repeated interventional procedure rates (p=0.164). Triglyceride values were found to be statistically different between groups (p=0.040). TyG was found higher in group 2 (p= 0.04). According to the binary logistic regression model, only TyG was found to have a significant effect as a diagnostic factor (p=0.011). TyG was also significantly correlated with the Rutherford (p=0.012) and GLASS classification severity (p<0.001). Peripheral arterial disease and disease severity could be easily monitored with simple calculable TyG. In this way, precautions could be taken, and morbidities could be prevented.

Resumen La enfermedad arterial periférica es una manifestación clínica importante causada por la aterosclerosis. Es una causa común de morbilidad y mortalidad en todo el mundo. Se ve comúnmente en hombres y la prevalencia aumenta con la edad. Es más común con el tabaquismo, la hipertensión, la diabetes mellitus y la hiperlipidemia. Nuevos estudios investigan la relación entre el índice de triglicéridos-glucosa (TyG) y las enfermedades cardiovasculares. Los estudios que investigan la asociación de este índice y la enfermedad arterial periférica generalmente se realizan utilizando la clasificación de TASC. Nuestro objetivo fue estudiar esta asociación utilizando la nueva clasificación de GLASS (sistema global de estadificación anatómica de extremidades). Doscientos pacientes entre 25 a 90 años con diagnóstico de enfermedad arterial periférica e ingresados al hospital para angiografía arterial periférica entre julio de 2021 y diciembre de 2021, fueron evaluados retrospectivamente con parámetros sanguíneos e imágenes angiográficas. Los pacientes se dividieron en dos grupos: leves (grupo 1; n=58) y graves (grupo 2; n=142) según la clasificación de GLASS. No se observaron diferencias estadísticas para las comorbilidades y las tasas de procedimientos intervencionistas repetidos (p = 0,164). Los valores de triglicéridos se encontraron significativamente diferentes entre los grupos (p= 0,04). El índice de triglicéridos-glucosa se encontró más alto en el grupo 2 (p= 0,04). Según el modelo de regresión logística binaria, solo el índice de triglicéridos-glucosa resultó tener un efecto significativo como factor diagnóstico (p=0,011). El índice de triglicéridos-glucosa también se correlacionó significativamente con la gravedad de la clasificación de Rutherford (p=0,012) y la clasificación de GLASS (p<0,001). La enfermedad arterial periférica y la gravedad de la enfermedad podrían controlarse fácilmente con TyG calculable simple. De esta manera, se podrían tomar precauciones y prevenir morbilidades.

Abstract The hypercoagulable state continues after the Coronavirus 2019 (Covid 19) infection and prophylactic anticoagulants are recommended in this period. However, arterial and venous thromboembolic events can be observed during the convalescence period after the Covid 19. Here, we present the case of acute lower extremity arterial and venous thromboembolism developed in the post-Covid 19 period in a 77-years-old patient, under therapeutic doses of anticoagulant therapy (enoxparin 1mg/kg of weight every 12 hours). The patient, who had no previous history of arterial or venous thrombosis, was taken to emergency surgery with the diagnosis of ALI (acute limb ischemia) due to acute arterial thrombosis. An arterial thrombectomy was performed with the help of a 4F Fogarty catheter inserted from the left femoral artery under local anesthesia. All distal pulses of the patient were palpable in the postoperative period. After the platelet count became >100,000 mm3, 100 mg of acetylsalicylic acid daily was added to the therapeutic dose of enoxaparin sodium treatment. The patient was discharged, uneventfully, except for a minimal diameter increase secondary to deep venous thrombosis (DVT) on the fifth postoperative day, with a combination of enoxaparin and acetylsalicylic acid treatment. Endothelial injury, chronic immuno-thrombogenicity, and increased platelet aggregation in the post-Covid 19 recovery period can cause major thrombotic events, even weeks after the recovery. Anticoagulant therapy is recommended for thromboprophylaxis when the following statuses exist: ≥65 years, critical illness, cancer, prior VTE, thrombophilia, severe immobility, and elevated D- dimer. Combination treatment with long-term antiaggregant therapy may be prudent in thromboembolic events developed under anticoagulant therapy.

Resumen El estado de hipercoagulabilidad continúa después de la infección por Coronavirus 2019 (Covid-19) y la anticoagulación profiláctica se recomienda durante este período. Sin embargo, eventos tromboembólicos arteriales y venosos se pueden observar durante el período de convalecencia posterior al Covid-19. Se presenta el caso de trombosis venosa profunda (TVP) y arterial agudas de una extremidad inferior en una paciente de 77 años, bajo terapia anticoagulante (enoxparin 1mg/kg de peso, cada 12 horas), en el período post- Covid 19. La paciente, sin historia previa de trombosis arterial ni venosa, fue llevada a cirugía de emergencia con el diagnóstico de isquemia aguda de extremidades por trombosis arterial aguda. Se le realizó trombectomía arterial con la ayuda de un catéter Fogarty 4F insertado desde la arteria femoral izquierda bajo anestesia local. Todos los pulsos distales del paciente fueron palpables en el periodo postoperatorio. Después de que las plaquetas llegaron a ser mayores a100.000 mm3, 100 mg de ácido acetilsalicílico diarios se añadieron a la dosis terapéutica del tratamiento con enoxaparina sódica. La paciente fue dada de alta sin incidencias, excepto por un mínimo aumento de diámetro secundario a la TVP, al quinto día postoperatorio con la combinación de enoxaparina y ácido acetilsalicílico. La lesión endotelial, la inmunotrombogenicidad crónica y la agregación plaquetaria aumentada en el período de recuperación posterior a Covid-19 pueden causar eventos trombóticos importantes incluso semanas después de la recuperación. La combinación con terapia antiagregante a largo plazo puede ser prudente en los casos de eventos tromboembólicos desarrollados en pacientes con terapia anticoagulante.

Abstract We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.