SUMMARY OBJECTIVE: Inflammation plays a key role in the pathogenesis of postoperative atrial fibrillation after coronary artery bypass graft surgery. In this study, we aimed to investigate the changes in mean platelet volume and platelet values during the spring and autumn seasons in patients who underwent isolated coronary artery bypass graft surgery and the possible effect of these occurrences on postoperative atrial fibrillation. METHODS: Consecutive patients who underwent elective isolated coronary bypass surgery at our clinic in the spring and autumn months, between August 2020 and July 2022, were retrospectively included in this study. Variables were evaluated according to the spring and autumn seasons. Patients who did not develop in-hospital postoperative atrial fibrillation were identified as Group 1, and those who did constituted Group 2. RESULTS: A total of 622 patients were included in the study. The patients were divided into two groups: those who were operated on in the spring (n=277, median age=62 years, male gender ratio=77.3%) and those who were operated on in the autumn (n=345, median age=61 years, male gender ratio=81.4%). There was no statistically significant difference between the patients operated on in both seasons in terms of age, gender, hypertension rates, and the frequency of chronic obstructive pulmonary disease. In multivariate analysis, being over 70 years old (OR: 1.934, 95% confidence interval (CI) 1.489–2.995, p<0.001), having a left ventricular ejection fraction below 30% (OR: 1.550, 95%CI 1.190–2.236, p=0.012), and having chronic obstructive pulmonary disease (OR: 1.663, 95%CI 1.339–2.191, p<0.001) were found to be independent predictors in predicting the development of postoperative atrial fibrillation. CONCLUSION: In this study, we first demonstrated that mean platelet volume and platelet mass index values were higher in patients in the autumn months. Additionally, for the first time in the literature, we showed that there is a significant relationship between platelet mass index value and the development of postoperative atrial fibrillation in patients who underwent isolated coronary artery bypass graft. OBJECTIVE study METHODS months 202 2022 inhospital hospital 1 2 RESULTS 62 groups n=277, n277 n 277 (n=277 age62 age age=6 ratio=77.3% ratio773 ratio 77 3 n=345, n345 345 (n=345 age61 61 ratio=81.4%. ratio814 ratio=81.4% . 81 4 ratio=81.4%) rates analysis 7 OR (OR 1934 934 1.934 95 CI (CI 14892995 489 995 1.489–2.995 p<0.001, p0001 p p<0.001 , 0 001 30 1550 550 1.550 95CI 11902236 190 236 1.190–2.236 p=0.012, p0012 p=0.012 012 p=0.012) 1663 663 1.663 13392191 339 191 1.339–2.191 CONCLUSION Additionally literature 20 6 n=277 n27 27 (n=27 age6 age= ratio=77.3 ratio77 n=345 n34 34 (n=34 ratio81 ratio=81.4 8 193 93 1.93 9 1489299 48 99 1.489–2.99 p000 p<0.00 00 155 55 1.55 1190223 19 23 1.190–2.23 p001 p=0.01 01 166 66 1.66 1339219 33 1.339–2.19 n=27 n2 (n=2 ratio=77. ratio7 n=34 n3 (n=3 ratio8 ratio=81. 1.9 148929 1.489–2.9 p00 p<0.0 15 5 1.5 119022 1.190–2.2 p=0.0 16 1.6 133921 1.339–2.1 n=2 (n= ratio=77 n=3 ratio=81 1. 14892 1.489–2. p0 p<0. 11902 1.190–2. p=0. 13392 1.339–2. n= (n ratio=7 ratio=8 1489 1.489–2 p<0 1190 1.190–2 p=0 1339 1.339–2 ratio= 148 1.489– p< 119 1.190– p= 133 1.339– 14 1.489 11 1.190 13 1.339 1.48 1.19 1.33 1.4 1.1 1.3

ABSTRACT Postoperative pain after cardiac surgery plays an important role in the patient’s recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade. patients patient s process particular complications analgesics anesthesia block clinic

SUMMARY OBJECTIVE: Postoperative acute kidney injury is an important problem that can occur after coronary artery bypass graft operations, and it is important to identify risky patient groups preoperatively. This study aimed to investigate the importance of preoperative syndecan-1 levels in predicting acute kidney injury after elective coronary artery bypass graft operations accompanied by cardiopulmonary bypass. METHODS: Patients who underwent coronary artery bypass graft operation in our clinic between March 1 and May 10, 2022, were included in this prospective study. Patients who did not develop acute kidney injury in the postoperative period were recorded as group 1 and patients who developed it were recorded as group 2. RESULTS: A total of 79 patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass were included in the study. There were 55 patients in group 1 and 24 patients in group 2. There was no difference between the groups in terms of age, gender, diabetes mellitus, body mass index, smoking, and hyperlipidemia rates. In multivariate logistic regression analysis, increased blood product use (odds ratio 1.634; 95%CI 1.036–2.579; p=0.035), preoperative high creatinine (odds ratio 59.387; 95%CI 3.034–1162.496; p=0.007), and high syndecan-1 (odds ratio 1.015; 95%CI 1.002–1.028; p=0.025) were independent predictors of acute kidney injury. CONCLUSION: This study revealed that elevated preoperative syndecan-1 is associated with acute kidney injury after isolated coronary artery bypass graft accompanied by cardiopulmonary bypass and has prognostic utility independent of other recognized risk factors. OBJECTIVE preoperatively syndecan1 syndecan syndecan- METHODS 10 2022 2 RESULTS 7 5 age gender mellitus index smoking rates analysis odds 1.634 1634 634 95CI CI 95 1.036–2.579 10362579 036 579 p=0.035, p0035 p p=0.035 , 0 035 p=0.035) 59.387 59387 59 387 3.034–1162.496 30341162496 3 034 1162 496 p=0.007, p0007 p=0.007 007 p=0.007) 1.015 1015 015 1.002–1.028 10021028 002 028 p=0.025 p0025 025 CONCLUSION factors 202 1.63 163 63 9 1.036–2.57 1036257 03 57 p003 p=0.03 59.38 5938 38 3.034–1162.49 3034116249 116 49 p000 p=0.00 00 1.01 101 01 1.002–1.02 1002102 02 p=0.02 p002 20 1.6 16 6 1.036–2.5 103625 p00 p=0.0 59.3 593 3.034–1162.4 303411624 11 4 1.0 1.002–1.0 100210 1. 1.036–2. 10362 p0 p=0. 59. 3.034–1162. 30341162 1.002–1. 10021 1.036–2 1036 p=0 3.034–1162 3034116 1.002–1 1002 1.036– 103 p= 3.034–116 303411 1.002– 100 1.036 3.034–11 30341 1.002 1.03 3.034–1 3034 1.00 3.034– 303 3.034 30 3.03 3.0 3.

Abstract Introduction: Rhythm problems are the most observed complications following coronary artery bypass grafting (CABG), the most common being postoperative atrial fibrillation (PoAF), with an incidence reaching 50% of the patients. In this study, we aimed to investigate the predictive importance of prognostic nutritional index (PNI) and visceral adiposity index (VAI) in predicting PoAF, which occurs after CABG accompanied by cardiopulmonary bypass. Methods: Patients who underwent isolated CABG with cardiopulmonary bypass between June 15 and October 15, 2019, were prospectively included in the study. Patients who did not develop in-hospital PoAF were identified as Group 1, and those who did constituted Group 2. Results: PoAF developed in 55 (27.6%) patients (Group 2). The mean age of the 144 patients included in Group 1 and 55 patients in Group 2 were 56.9±8.7 and 64.3±10.2 years, respectively (P<0.001). In multivariate analysis Model 1, age (odds ratio [OR]: 1.084, confidence interval [CI]: 1.010-1.176, P=0.009), chronic obstructive pulmonary disease (OR: 0.798, CI: 0.664-0.928, P=0.048), and PNI (OR: 1.052, CI: 1.015-1.379, P=0.011) were determined as independent predictors for PoAF. In Model 2, age (OR: 1.078, CI: 1.008-1.194, P=0.012), lymphocyte counts (OR: 0.412, CI: 0.374-0.778, P=0.032), and VAI (OR: 1.516, CI: 1.314-2.154, P<0.001) were determined as independent predictors for PoAF. Conclusion: In this study, we determined that low PNI, a simply calculable and cheap parameter, along with high VAI were risk factors for PoAF. Introduction CABG, , (CABG) (PoAF) 50 study (PNI (VAI Methods 2019 inhospital hospital Results 5 27.6% 276 27 6 (27.6% . 2) 14 56987 56 9 8 7 56.9±8. 643102 64 3 10 64.3±10. years P<0.001. P0001 P P<0.001 0 001 (P<0.001) odds OR [OR] 1084 084 1.084 CI [CI] 1.0101.176, 10101176 1.010 1.176, 010 176 1.010-1.176 P=0.009, P0009 P=0.009 009 P=0.009) (OR 0798 798 0.798 0.6640.928, 06640928 0.664 0.928, 664 928 0.664-0.928 P=0.048, P0048 P=0.048 048 P=0.048) 1052 052 1.052 1.0151.379, 10151379 1.015 1.379, 015 379 1.015-1.379 P=0.011 P0011 011 1078 078 1.078 1.0081.194, 10081194 1.008 1.194, 008 194 1.008-1.194 P=0.012, P0012 P=0.012 012 P=0.012) 0412 412 0.412 0.3740.778, 03740778 0.374 0.778, 374 778 0.374-0.778 P=0.032, P0032 P=0.032 032 P=0.032) 1516 516 1.516 1.3142.154, 13142154 1.314 2.154, 314 154 1.314-2.154 Conclusion parameter (CABG (PoAF 201 27.6 (27.6 5698 56.9±8 64310 64.3±10 P000 P<0.00 00 (P<0.001 [OR 108 08 1.08 [CI 0101 1.0101.176 1010117 1010 1.01 1176 1.176 01 17 1.010-1.17 P=0.00 079 79 0.79 6640 0.6640.928 0664092 0664 0.66 0928 0.928 66 92 0.664-0.92 P004 P=0.04 04 105 05 1.05 0151 1.0151.379 1015137 1015 1379 1.379 37 1.015-1.37 P=0.01 P001 107 07 1.07 0081 1.0081.194 1008119 1008 1.00 1194 1.194 19 1.008-1.19 041 41 0.41 3740 0.3740.778 0374077 0374 0.37 0778 0.778 77 0.374-0.77 P003 P=0.03 03 151 51 1.51 3142 1.3142.154 1314215 1314 1.31 2154 2.154 31 1.314-2.15 20 27. (27. 569 56.9± 6431 64.3±1 P00 P<0.0 (P<0.00 1.0 1.0101.17 101011 101 117 1.17 1.010-1.1 P=0.0 0.7 0.6640.92 066409 066 0.6 092 0.92 0.664-0.9 1.0151.37 101513 137 1.37 1.015-1.3 1.0081.19 100811 100 119 1.19 1.008-1.1 4 0.4 0.3740.77 037407 037 0.3 077 0.77 0.374-0.7 1.5 1.3142.15 131421 131 1.3 215 2.15 1.314-2.1 (27 56.9 643 64.3± P0 P<0. (P<0.0 1. 1.0101.1 10101 11 1.1 1.010-1. P=0. 0. 0.6640.9 06640 06 09 0.9 0.664-0. 1.0151.3 10151 13 1.015-1. 1.0081.1 10081 1.008-1. 0.3740.7 03740 0.374-0. 1.3142.1 13142 21 2.1 1.314-2. (2 56. 64.3 P<0 (P<0. 1.0101. 1.010-1 P=0 0.6640. 0.664-0 1.0151. 1.015-1 1.0081. 1.008-1 0.3740. 0.374-0 1.3142. 1.314-2 ( 64. P< (P<0 1.0101 1.010- P= 0.6640 0.664- 1.0151 1.015- 1.0081 1.008- 0.3740 0.374- 1.3142 1.314- (P< (P

Abstract Objective: Del Nido cardioplegia (DNC) has been used in pediatric cardiac surgery for many years with a single dose application and its usage in adult cardiac surgery has been increasing in recent years, with results being published. In this study, we aimed to investigate the effect of DNC on the development of postoperative atrial fibrillation (PoAF). Methods: In this retrospective observational comparative study, 255 patients who underwent isolated on-pump coronary artery bypass grafting, between January 2019 and November 2019, were enrolled. The patients were divided into two groups: DNC (n=132) and blood cardioplegia (BC) (n=123). Intraoperative and postoperative data were evaluated and compared in terms of the development of PoAF. Results: We found that the development of PoAF and the length of hospital stay remain significantly higher in the BC group (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp time and the cardioplegia volume delivered were significantly lower in the DNC group (P=0.042, P<0.001, respectively). In multivariate logistic regression analysis, only higher cardioplegia volume was determined as an independent predictor for PoAF development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not found difference between groups in terms of troponin T, inotropic drug support, need for intraaortic balloon pump and mortality. Conclusion: This study showed that DNC can be used safely in adult coronary bypass surgery and PoAF development effect is reduced.

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

Abstract Ventricular free wall rupture is a fatal mechanical complication of acute myocardial infarction. In some cases it can be represented as subacute clinic and may not cause death in a few minutes. Acute pseudo-aneurysms are extremely unstable and bound to fatal rupture. Herein we report a male patient who suffered dyspnea and mild chest pain, 4 weeks after acute ST-segment elevation myocardial infarction.

Abstract Objective: To investigate the effect of continuous lung ventilation with low tidal volume on oxidation parameters, such as thiol/disulphide homeostasis and albumin-adjusted ischemia-modified albumin (AAIMA), during cardiopulmonary bypass (CBP) in coronary artery bypass grafting (CABG). Methods: Seventy-four patients who underwent elective CABG with CPB were included in the study. Blood samples were taken in the preoperative period, 10 minutes after CPB, and six and 24 hours postoperatively. Patients were assigned to the continuous ventilation group (Group 1, n=37) and the non-ventilated group (Group 2, n=37). The clinical characteristics, thiol/disulphide homeostasis, ischemia-modified albumin (IMA), and AAIMA levels of the patients were compared. Results: A significant difference was found between the groups regarding native thiol, total thiol, and IMA levels at the postoperative 24th hour (P=0.030, P=0.031, and P=0.004, respectively). There was no difference between the groups in terms of AAIMA. AAIMA levels returned to preoperative levels in Groups 1 and 2, at the 6th and 24th postoperative hours, respectively. Length of hospital stay was significantly shorter in Group 1 (P<0.001) than in Group 2. Conclusion: Continuous ventilation during CPB caused an increase in native and total thiol levels, an earlier return of AAIMA levels, and shorter hospital stay. Continuous ventilation may reduce the negative effects of CPB on myocardium (Table 2, Figure 1, and Reference 31).

Abstract Objective: Postoperative atrial fibrillation (PoAF) is a common complication after coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the association between development of PoAF and vitamin D levels in patients undergoing isolated CABG. Methods: This prospective randomized clinical trial was conducted on the patients with isolated CABG. The study was terminated when 50 patients in both PoAF(+) group and PoAF(-) group were reached. Development of AF until discharge period was assessed. Vitamin D level was measured immediately after AF; it was measured on the discharge day for the patients without PoAF. Predictive values of the independent variables were measured for the development of PoAF. Results: The groups were separated as PoAF(-) group (66% male, mean age 58.18±10.98 years) and PoAF(+) group (74% male, mean age 61.94±10.88 years). 25(OH) vitamin D level (OR=0.855, 95% CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483, P=0.013) were identified as an independent predictor of postoperative AF after CABG surgery in multivariate analysis. The cut-off level for 25(OH) vitamin D level in receiver-operating characteristic curve analysis was determined as 7.65 with sensitivity of 60% and specificity of 64% for predicting PoAF (area under the curve: 0.679, P=0.002). Conclusion: Vitamin D level is considered an independent predictor for development of PoAF. Lower vitamin D levels may be one of the reasons for PoAF.