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Demirsoy E, Mavioglu I, Dogan E, Gulmez H, Dindar I, Erol MK. The Feasibility and Early Results of Multivessel Minimally Invasive Coronary Artery Bypass Grafting for All Comers. J Clin Med 2023; 12:5663. [PMID: 37685730 PMCID: PMC10488478 DOI: 10.3390/jcm12175663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES Cardiovascular surgery advancements have emerged with various minimally invasive approaches for treating multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. We present our clinical experience and minimally invasive coronary bypass techniques through minithoracotomy, which we apply without selection to patients who have decided to have elective surgery for multivessel isolated coronary artery disease. METHODS It consists of 230 consecutive patients operated by the same team with this method between July 2020 and September 2022. The patients were assigned to one of the two methods preoperatively to their accompanying comorbidities and operated on either with blood cardioplegia via 5 to 7 cm left anterior minithoracotomy, with on-pump clamped technique or without pump via left anterolateral minithoracotomy. RESULTS Mortality was observed in two of our patients (0.9%), but myocardial infarction was not observed in our patients in the early postoperative period. None of our patients required conversion to sternotomy (0%). Five patients' needed reoperation from the same incision due to postoperative bleeding (2.2%), and atrial fibrillation developed in 17 patients in the postoperative period (7.4%). The mean number of bypasses was found to be 3.0 ± 0.9. CONCLUSIONS Minimally invasive coronary artery bypass surgery via minithoracotomy can be routinely reproduced safely. More long-term results and more multicenter studies are needed for more widespread acceptance of the technique.
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Affiliation(s)
- Ergun Demirsoy
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Ilhan Mavioglu
- Division of Cardiovascular Surgery, Private Practice, Sisli, 34394 Istanbul, Turkey;
| | - Emre Dogan
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Harun Gulmez
- Division of Cardiovascular Surgery, Sisli Kolan International Hospital, Kaptanpaşa Mahellesi Darulaceze Caddesi No 14, Sisli, 34384 Istanbul, Turkey
| | - Ismet Dindar
- Division of Cardiology, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
| | - Mustafa Kemal Erol
- Division of Cardiology, Sisli Kolan International Hospital, 34384 Istanbul, Turkey
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Mavioglu I. Minimally Invasive Off-Pump Anaortic Complete Arterial Coronary Artery Bypass: How to Do It? Innovations (Phila) 2023; 18:376-379. [PMID: 37464774 DOI: 10.1177/15569845231185333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Minimally invasive direct coronary artery bypass has empowered coronary artery bypass grafting to compete with the appeal of percutaneous coronary procedures. Successful results of off-pump coronary artery bypass surgery and without touching the aorta have facilitated the development and use of minimally invasive methods. Multivessel coronary bypass surgery performed using a minimally invasive method through a small thoracotomy in the left chest with off-pump, anaortic, and all-arterial grafts is described step by step. Technical considerations, description of operation stages, and tips and pitfalls will be examined. A 64-year-old male patient with no known comorbidities except smoking revealed 3 vessels and a side vessel disease, and the heart team decided on surgical revascularization with a low-risk procedure. Experienced surgeons may perform this operation successfully, and the development of efficient simulation systems will increase its use.
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Affiliation(s)
- Ilhan Mavioglu
- Cardiovascular Surgery, Cardiac Surgical Clinic of Private Cardiac Surgeons (CSCPCS), Istanbul, Turkey
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Mavioglu I. Anaortic With No Touch to the Aorta Is a Central Technique to Decrease Invasiveness of CABG. Innovations (Phila) 2023; 18:295. [PMID: 37078615 DOI: 10.1177/15569845231168616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Ilhan Mavioglu
- Cardiac Surgical Clinic of Private Cardiac Surgeons, Istanbul, Turkey
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Mavioglu I, Vallely MP. Minimally invasive off-pump anaortic coronary artery bypass (MACAB). J Card Surg 2022; 37:4944-4951. [PMID: 36378893 DOI: 10.1111/jocs.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimally invasive direct coronary artery bypass has enabled coronary artery bypass graft to compete with the appeal of less invasive percutaneous coronary procedures. Favorable results of coronary artery bypass surgery performed without the use of cardiopulmonary bypass and without touching the aorta (anOPCAB) have enabled the development and use of minimally invasive methods. METHODS Between 2016 and 2021, 112 patients underwent multivessel coronary bypass surgery performed using a minimally invasive method through a small thoracotomy in the left chest with off-pump, anaortic, and all-arterial grafts (Minimally Invasive Off-Pump Anaortic Coronary Artery Bypass [MACAB]). Patient data were collected and retrospectively analyzed. Eight series from the literature using the multivessel mini-OPCAB and MACAB technique were also evaluated. RESULTS Collectively, from the literature, 2729 patients underwent an average of 2.4 bypasses with an early mortality rate of 0.7% and a stroke rate of 0.16%. In our MACAB case series, 112 patients underwent an average of 2.9 bypasses with a mortality rate of 1.8% and a stroke rate of 0%. CONCLUSION MACAB can be performed safely by experienced surgeons and reduces neurological injury and surgical trauma and may be a good alternative for multivessel stenting. Simulation systems are essential for its dissemination, and teams dedicated to coronary surgery-with subspecialty expertise-are necessary to achieve good outcomes.
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Affiliation(s)
- Ilhan Mavioglu
- Cardiovascular Surgery, Cardiac Surgical Clinic of Private Cardiac Surgeons, Istanbul, Turkey
| | - Michael P Vallely
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York, USA
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Abstract
Use of the internal thoracic artery is the gold standard for coronary bypass surgery. Bilateral internal thoracic artery use is encouraged, especially in young patients. There are various techniques of harvesting. The LigaSure device has been used successfully as a low heat generating electrothermal vessel sealer in laparoscopic and open surgery for a long time. An internal thoracic artery harvesting technique is described, using a LigaSure Maryland Jaw 23-cm open sealer/divider through a thoracotomy and LigaSure Exact Dissector through a sternotomy. LigaSure devices can be used for pedicled or skeletonized internal thoracic artery harvesting with almost equal precision and safety.
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Affiliation(s)
- Ilhan Mavioglu
- Department of Cardiovascular Surgery, Irmet Hospital Cerkezkoy, Tekirdag, Turkey
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Affiliation(s)
- Oguz Koksel
- Department of Thoracic Surgery, Mersin Universitesi Tip FakOltesi Hastanesi, Mersin, Turkey.
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Aytacoglu BN, Sucu N, Tamer L, Polat A, Gul A, Degirmenci U, Mavioglu I, Dikmengil M. Iloprost for the attenuation of ischaemia/reperfusion injury in a distant organ. Cell Biochem Funct 2006; 24:341-6. [PMID: 16708361 DOI: 10.1002/cbf.1223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to investigate antioxidant and cytoprotective properties of iloprost in a distant organ after ischaemia reperfusion injury. Male Wistar rats were divided into two groups. After application of anesthaesia both hindlimbs were occluded. A 2-h reperfusion procedure was carried out after 60 min of ischemia. Study group (STU) rats (n=10) received 10 microg kg(-1) iloprost in 1 ml of saline from the tail vein 10 min before reperfusion. Control (CON) group rats (n=10) received an equal amount of saline. The rats were sacrificed by injection of a high dose of thiopentone sodium. Blood and tissue samples (right kidneys) were taken for analysis. Differences in malondialdehyde (MDA), myeloperoxidase (MPO), Na+-K+ ATPase and total antioxidant capacity (TAC) between the groups were analysed. MPO, MDA and TAC levels in the sera of CON and STU groups were 1.60+/-0.26 U l(-1), 11.42+/-5.23 nmol ml(-1), 8.30 x 10(-2)+/- 3.93 x 10(-2) nmol ml(-1) h(-1) and 1.07+/-0.11 U l(-1), 7.60+/-1.81 nmol ml(-1) and 0.15+/-3.23 x 10(-2) nmol ml(-1) h(-1) (p=0.0001, p=0.043 and p=0.0001 respectively). MPO, ATPase and MDA levels in kidneys for CON and STU groups were 1.24+/-0.58 U g(-1), 85.70+/-52.05 nmol mg(-1), 17.90+/-7.40 nmol ml(-1) and 0.78+/-0.31 U g(-1), 195.90+/-56.13 nmol mg(-1) and 10.10+/-0.99 nmol ml(-1) (p=0.046, p=0.0001 and p=0.009 respectively). When given prior to reperfusion, the positive effect of iloprost in the attenuation of distant organ reperfusion injury has been demonstrated.
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Affiliation(s)
- Barlas N Aytacoglu
- Department of Cardiovascular Surgery, Mersin University, School of Medicine, Mersin, Turkey.
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Mavioglu I, Sucu N, Aytacoglu BN, Gul A, Dikmengil M. Primary aorto-colic fistula arising from a post-traumatic aortic pseudoaneurysm. Eur J Vasc Endovasc Surg 2005; 29:97-100. [PMID: 15570281 DOI: 10.1016/j.ejvs.2004.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- I Mavioglu
- Cardiovascular Surgery Department, School of Medicine, Mersin University, TR-33079 Mersin, Turkey.
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Dikmengil M, Sucu N, Aytacoglu BN, Mavioglu I. Leaflet escape in a TRI bileaflet rotatable mitral valve. J Heart Valve Dis 2004; 13:638-40. [PMID: 15311872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Acute prosthetic valve dysfunction is a critical condition for any patient, and is associated with a high mortality. A 24-year-old man who had undergone mitral valve replacement with a TRI bileaflet valve four months previously at another center was admitted with acute-onset left ventricular failure. Echocardiography showed massive mitral insufficiency which was suggestive of a stuck valve. Emergency surgery was carried out, at which the cranial leaflet was found to be stuck open. There was no tissue impingement and thrombosis, the caudal leaflet was absent, and there were no signs of endocarditis or pannus formation. The TRI valve was removed and a replacement 25 mm bileaflet mechanical valve inserted. The embolized leaflet was found in the terminal aorta, but the patient died on day 66 after surgery due to sepsis which had developed from aspiration pneumonia. This is the first report of leaflet escape and terminal aortic embolization with the TRI bileaflet rotatable mitral valve. Acute deterioration of a patient with a prosthetic heart valve should suggest valve dysfunction for which appropriate treatment is rapid relief of the failing left ventricle and replacement of the defective valve with a functioning prosthesis.
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Affiliation(s)
- Murat Dikmengil
- Mersin University, School of Medicine, Department of Cardiovascular Surgery, Mersin, Turkey
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Abstract
Recent experimental studies have described protective effect of ischemic preconditioning (IPC) on ischemia-reperfusion (I/R) injury of the intestine. We hypothesize that to reach a new point of view on the effect of IPC in intestinal barrier function, the relationship between I/R-induced mucosal injury and apoptosis must first be clarified. The present study was undertaken to investigate the role of IPC on intestinal apoptosis and probable contributions of bcl-2 expression to this process. We also investigated the effect of intestinal IPC on ileal malondyaldihyde levels. Forty-four male Wistar rats were randomized into four groups each consisting of 11 rats: sham-operated control, I/R group (30 min of superior mesenteric artery occlusion), IPC-I/R group (10 min of temporary artery occlusion prior before an ischemic insult of 30 min), and IPC alone group (10 min of preconditioning). Twenty-four hours later, ileum samples were obtained. Ileal malondyaldihyde levels were increased in the I/R group (31.9 +/- 18.8 vs. 106.8 +/- 39.8) but not in the IPC alone and IPC-I/R groups (38.1 +/- 13.6 and 44.7 +/- 12.7; P < 0.01). The number of apoptotic cells was significantly lower in IPC-I/R group than that of I/R group, and these findings were further supported by DNA laddering and M30 findings. Diminished bcl-2 expression observed in the ileal specimens of I/R group was prevented by IPC. Our results indicate that IPC may provide a protective effect on ileal epithelium and that this effect is probably the result of a significant increase in the expression of bcl-2 after the insult. The reversal of apoptosis by IPC might help preserving the vitality of intestinal structures that have a critical function, cessation of which often leads to multiorgan dysfunction syndrome.
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Affiliation(s)
- Ismail Cinel
- Department of Anesthesiology and Reanimation, Mersin University School of Medicine, Mersin, Turkey
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Mavioglu I, Veli Dogan O, Ozeren M, Dolgun A, Yucel E. Surgical management of chronic total occlusion of abdominal aorta. J Cardiovasc Surg (Torino) 2003; 44:87-93. [PMID: 12627078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
AIM The surgical management of the totally occluded abdominal aorta is highly complex and possible complications are more likely to be seen. We reviewed our experience to make a base for future endoluminal procedures. METHODS Seventy-one patients with totally occluded abdominal aorta were operated between 1985 and 1998 in a main referral hospital of the social security organization and the results of vascular interventions were evaluated retrospectively. Juxtarenal aortic occlusion was seen in 52% of these patients. All the patients were operated using the transperitoneal approach and adequate dissection to control renal arteries. Limited thrombectomy through infrarenal aortotomy without transecting the aorta was done and continued with standard aortic graft insertion except for 1 patient with porcelain aorta. RESULTS Follow-up was 76.9+/-41.9 (SD) months. Fourteen patients had concurrent femoro-distal bypass and 2 patients had concurrent renal bypass. Perioperative mortality was 5.6% and 26.5% of patients needed a second intervention during follow-up. Five-, 10- and 13-year survival and freedom from secondary operation was as follows: 84%, 56% and 44%, 81%, 54% and 42%. Cumulative primary and secondary graft patencies at 5- and 10-years were 68%, 63% and 92%, 92%, respectively. CONCLUSIONS Surgical intervention is beneficial for patients with totally occluded aorta even if ischemic complaints are relatively mild and stable. Acceptable mortality rates and long-term results form a basis for future endovascular interventions.
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Affiliation(s)
- I Mavioglu
- Department of Thoracic and Cardiovascular Surgery, Mersin University School of Medicine, Mersin, Turkey.
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Ozeren M, Han U, Mavioglu I, Simsek E, Soyal MFT, Guler G, Yucel E. Consequences of PTFE membrane used for prevention of re-entry injuries in rheumatic valve disease. Cardiovasc Surg 2002; 10:489-93. [PMID: 12379408 DOI: 10.1016/s0967-2109(02)00061-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The value of polytetrafluoroethylene (PTFE) surgical membrane as a pericardium substitute in patients who undergo reoperation for rheumatic valve disease is reported in this observational study. METHODS PTFE was used for pericardial closure in 56 rheumatic valve patients. During reoperation of seven cases, adhesions were classified as none, minimal, moderate to severe and scored in the sections of heart. Data found at reoperations were collected prospectively in all patients. RESULTS Seven of 56 patients reoperated mean period of 67.1+/-23.4 (SD) months later. No infection, complication and operative or late death attributable to the membrane were observed. There were two right ventricular, three minimal right atrial and one innominate vein lacerations during resternotomy and all of them were controlled. During histological examination, a microscopically significant foreign body reaction was found. CONCLUSION PTFE membrane produced an undesirable fibrous membrane that obscured the epicardial anatomy and hardened the dissection in patients with rheumatic heart disease.
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Affiliation(s)
- Murat Ozeren
- Department of Cardiovascular Surgery, S.S.K. Ankara Training Hospital, Turkey.
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Ozdülger A, Cinel I, Unlü A, Cinel L, Mavioglu I, Tamer L, Atik U, Oral U. Poly(Adp-ribose) synthetase inhibition prevents lipopolysaccharide-induced peroxynitrite mediated damage in diaphragm. Pharmacol Res 2002; 46:67-73. [PMID: 12208123 DOI: 10.1016/s1043-6618(02)00037-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although the precise mechanism by which sepsis causes impairment of respiratory muscle contractility has not been fully elucidated, oxygen-derived free radicals are thought to play an important role. In our experimental study, the effects of poly(ADP-ribose) synthetase (PARS) inhibition on the diaphragmatic Ca(2+)-ATPase, malondialdehyde (MDA), and 3-nitrotyrosine (3-NT) levels and additionally histopathology of the diaphragm in lipopolysaccharide (LPS)-induced endotoxemia are investigated.Thirty-two male Wistar rats, weighing between 180-200 g were randomly divided into four groups. The first group (control; n=8) received saline solution and the second (LPS group; n=8) 10 mgkg(-1) LPS i.p. 3-Aminobenzamide (3-AB) as a PARS inhibitor; was given to the third group (C+3-AB, n=8) 20 min before administration of saline solution while the fourth group (LPS+3-AB, n=8) received 3-AB 20 min before LPS injection. Six hours later, under ketamin/xylasine anesthesia diapraghmatic specimens were obtained and the rats were decapitated. Diaphragmatic specimens were divided into four parts, three for biochemical analyses and one for histopathologic assessment. In the LPS group, tissue Ca(2+)-ATPase levels were found to be decreased and tissue MDA and 3-NT levels were found to be increased (P<0.05). In the LPS+3-AB group, 3-AB pretreatment inhibited the increase in MDA and 3-NT levels and Ca(2+)-ATPase activity remained similar to those in the control group (P<0.05). Histopathologic examination of diaphragm showed edema between muscle fibers only in LPS group. PARS inhibition with 3-AB prevented not only lipid peroxidation but also the decrease of Ca(2+)-ATPase activity in endotoxemia. These results highlights the importance of nitric oxide (NO)-peroxynitrite (ONOO(-))-PARS pathway in preventing free radical mediated injury. PARS inhibitors should further be investigated as a new thearapetic alternative in sepsis treatment.
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Affiliation(s)
- Ali Ozdülger
- Department of Thoracic and Cardiovascular Surgery, Mersin University School of Medicine, Turkey
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Mavioglu I, Dogan OV, Ozeren M, Dolgun A, Yucel E. Valve repair for rheumatic mitral disease. J Heart Valve Dis 2001; 10:596-602. [PMID: 11603599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND AND AIM OF STUDY Mitral valve repair is the standard reparative technique for degenerative mitral disease, but results of valve repair in rheumatic disease are also encouraging. The outcomes after mitral valve repair for rheumatic disease at young age was evaluated for suitability of repair. METHODS A total of 319 patients (246 females, 73 males; mean age 31.3+/-0.5 years) underwent mitral valve repair for rheumatic mitral disease at the authors' institution between 1991 and 1998. Mean follow up was 51.9+/-1.2 months (range: 9-98 months), and was 88.7% complete. RESULTS Preoperatively, 47.6% of patients were in NYHA classes III and IV. Mitral stenosis was present in 87.5%, insufficiency in 5.3%, and stenosis/insufficiency in 7.2%. Concomitant procedures were performed in 32% of patients who had associated cardiac lesions. The intraoperative mortality, reoperation and reoperation mortality rates were 0.9%, 6.7% and 0%, respectively. During follow up there were 10 late deaths (3.5%), six of which were cardiac disease-related (2.1%). Postoperatively, 98% of patients were in NYHA classes I and II. CONCLUSION Valve repair in mitral disease is a standard technique, with low mortality, complication and reoperation rates, and good cardiac function and late survival. This approach is equally applicable to rheumatic mitral valve repair; hence, rheumatic mitral valves should also be repaired.
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Affiliation(s)
- I Mavioglu
- Cardiovascular Surgery Department, Ankara Teaching Hospital, Social Security Organization, Turkey
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Abstract
OBJECTIVES to retrospectively evaluate the role of vascular interventions in Behçet's disease with arterial involvement. So far, little information is available on the surgical approach for arterial involvement in Behçet's disease. MATERIAL AND METHODS between February 1989 and August 1997, among 178 patients with Behçet's disease referred to our clinic, vascular involvement was established in total of 67 patients (38%) which consisted of 59 venous (33%) and 12 (7%) arterial involvements requiring urgent surgical intervention. Primary arterial lesions were occlusive in one patient, aneurysm formation in nine or both in four. RESULTS twelve primary operations and 12 reoperations were performed. The reasons for reoperations were anastomotic aneurysms, graft occlusion, occlusion of native vessel, graft infection, bleeding from anastomosis and aortoenteric fistula. First reoperation was performed after a mean period of 6.4 months (1-15 months). Postoperative follow-up was 12-60 months (mean 36 months) and three patients died during follow-up. CONCLUSIONS the surgical results were not satisfactory because of progressive graft thrombosis and formation of new aneurysms at the anastomosis. Aggressive medical treatment should be combined when major vessel involvement occurs. All types of arterial punctures for angiography or blood gases should be minimised because of the risk of new aneurysm formation. Surgical intervention is indicated only in patients with a growing aneurysm, acute rupture or severe ischaemia.
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Affiliation(s)
- M Ozeren
- Department of Cardiovascular Surgery, SSK Ankara Training Hospital, Turkey
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