Background: Red blood cell (RBC) transfusion increases morbidity and mortality after cardiac surgery. Despite the use of patient blood management methods, blood transfusions may still be needed in cardiac surgery. This study aims to determine the risk factors for blood transfusions in isolated coronary bypass graft surgery with the use of a restrictive transfusion strategy along with individualized patient blood management. Methods: A total of 198 consecutive patients (28 females, 170 males; age range 38–87) who underwent isolated CABG surgery in single private hospital using a restrictive transfusion strategy between April 2015 and October 2020 were included in the study. Patients were divided into two groups: with RBC transfusion and without RBC transfusion. Preoperative, intraoperative, and postoperative values were compared between groups. The risk factors for transfusion and transfusion probability were analyzed. Results: Preoperative hematocrit level and female gender (OR: 0.752; 95% CI 0.639–0.884; p = 0.001; OR: 7.874; 95% CI 1.678–36.950; p = 0.009, respectively) were the statistically significant independent risk factors for red blood cell transfusion. In female patients, the RBC transfusion probability was 61.08% when the preoperative hematocrit was 30%. The intensive care unit and hospital stay were longer in the blood transfusion group. Conclusions: The risk factors for RBC transfusion were preoperative anemia and female gender in isolated CABG surgery with restrictive blood transfusion strategies. Keywords: anemia, blood transfusion, coronary artery bypass, patient blood management, restrictive blood transfusion
Infective endocarditis (IE) still has a high risk of mortality and morbidity, despite of developments in medical treatment. Intracranial hemorrhage is one of serious complication, which has poor outcome. We present a 30-year-old male with diagnosis of IE. He had severe aortic regurgitation and oscillating vegetations on both side of the aortic valve. Although there was no neurological symptom in preoperative period, cranial magnetic resonance imaging (MRI) revealed millimetric size ischemic lesions at the right cerebral hemisphere. We performed Ozaki procedure. However, cerebral hemorrhage occurred on the first postoperative day. Computerized tomography (CT) revealed hematoma in parietal and occipital lobes. He was treated with conservative anti-edema therapy and discharged from the hospital on the 25th day with minor visual defect of his eye. Echocardiography control revealed mild aortic regurgitation without any other pathologic finding after 18 months. Aortic neocuspidization by using using of glutaraldehyde treated autologous pericardium decreases the risk of fibrosis and calcification, and thrombosis events. Possibility of suspending the anticoagulant and antiplatelet regimen is a significant advantage in this type of repair. Ozaki procedure might be the first-choice surgical reconstruction technique in anatomically suitable IE cases.
Background and Aim: Attempting to place an aortic cross-clamp may complicate surgery and post operative outcomes in patients who have mediastinal adhesions or in those with extensive aortic calcification. Although right sided cardiac surgery via thoracotomy is not a new technique in these patients, robotic-assisted intracardiac repair without cross-clamping was not reported in a large group of patients previously. In this study, the safety of robotic-assisted cardiac surgery without aortic cross-clamping was examined. Methods: From January 2010 to March 2020, 304 patients underwent robotic-assisted cardiac surgery in our center and in 25 of these patients (8.2%) with a mean age of 65.5±20 years myocardial protection was succeeded with moderate hypothermic ventricular fibrillatory arrest. Severe pericardial adhesions or existence of highly calcified ascending aorta were the indications for fibrillatory arrest during robotic assistant surgery. Results: Most patients were in NYHA class ≥II (88.0%) and mean logistic Euroscore value was 18.5±22.3. The type of the operations were mitral/tricuspid valve repair/replacement, Cryoablation, ASD closure and pericardiectomy. CPB times were 141.5±47 (min 77- max 252) minutes. There was no case of conversion to open thoracotomy or sternotomy. Hemiparesis was observed in one patient. Two patients with 78.2 and 81.9 Euroscore values had mesenteric ischemia and multi-organ failure, respectively, and died at postoperative period. Conclusions: Robotic-assisted cardiac surgery without cross-clamping may provide reasonable outcomes in patients with severe aortic calcification or mediastinal adhesions undergoing intracardiac repair. These acceptable outcomes may encourage surgeons to perform this approach in appropriate group of patients.