1. | Front Matter Pages I - XII |
REVIEW | |
2. | Vasoplegia After Cardiopulmonary Bypass: Current Approaches Elvin Kesimci doi: 10.14744/GKDAD.2024.32659 Pages 125 - 131 Vasoplegia is a kind of distributive form of circulatory shock. It is commonly observed intraoperatively during cardiopulmonary bypass (CPB), after weaning from CPB or in the first postoperative 24 h follow-up in the intensive care unit (ICU). As CPB is still a cornerstone in surgical management of cardiovascular diseases, the incidence of vasoplegia increases up to 40% in cardiac surgical patients. The recognized characteristics are reduced blood pressure with profound peripheral vasodilation despite a preserved cardiac output. The pathophysiology is complex and mainly triggered by the systemic inflammatory response caused by CPB and surgical trauma. Early identification and prompt management of vasoplegia is crucial to prevent development of organ failure and longer hospital and ICU stay with increased morbidity and mortality. In this review, the risk factors, pathophysiology and current management approaches of vasoplegia after CPB are discussed. |
RESEARCH ARTICLE | |
3. | Effects of Cardiopulmonary Bypass on Systemic Inflammatory Response and Organ Dysfunction in Patients Who Had Low Left Ventricular Ejection Fraction Underwent Coronary Artery Surgery Mert Özer, Olcay Yaldır, Arife Şengel, Fatma Taneli, Melek Çivi, Tülün Öztürk doi: 10.14744/GKDAD.2024.00377 Pages 132 - 138 Objectives: Cardiac surgery with cardiopulmonary bypass (CPB) causes systemic inflammatory response and multiple organ dysfunction. The release of cytokines including tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and interferon-gamma (IFN-γ) was reported to be the main reason of multiorgan failure after CPB. The aim of this study is to investigate the effects of cardiopulmonary bypass on the systemic inflammatory response and the relationship between cytokine responses and organ dysfunction in patients with poor left ventricles underwent coronary revascularization with cardiopulmonary bypass. Methods: Thirty patients who had depressed left ventricular function (EF≤35%) and underwent CABG surgery were included in this prospective observational study. The maintenance of anesthesia and CPB was performed in accordance with institutional standards. After induction of anesthesia, a thermodilution pulmonary artery catheter was placed via the right internal jugular vein. Peripheral blood samples for the assessment of TNF-α, IL-6, IL-8 and IL-10 levels were taken immediately after the induction of anesthesia (T0), at 30th minute (T1) after the beginning of CPB and at the 1st (T2), 3rd (T3), 6th (T4), and 24th (T5) hours after CPB. Hemodynamic parameters including mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), left ventricular end diastolic pressure (LVEDP) and cardiac index (CI) were also recorded in these time intervals. Multiorgan dysfunction score (MODS) was recorded daily for 3 days after the surgery. Results: IL-6 and IL-8 peaked at the 3rd hour after CPB and returned to the level of the first half hour at the 24th hour. IL-10 peaked at the 1st hour after CPB. TNF-α increased in the first half hour after the beginning of CPB, and this level was maintained. A significant positive correlation was found between IL-6 levels at the 3rd hour and pulmonary, cardiopulmonary and renal dysfunction (r=0.3, p=0.04; r=0.4, p=0.003; r=0.3, p=0.04, respectively). Also, there was a correlation between IL-10 levels at the 6th hour and renal dysfunction (r=0.5, p=0.001) and between IL-6 levels at the 6th hour (r=0.3, p=0.05) and IL-8 levels at the 3rd hour (r=0.3, p=0.03) and hematological dysfunction. Conclusion: IL-6 and IL-8 peaked at the 3rd hour after CPB; IL-10 peaked at the 1st hour after CPB. TNF-α reached its highest level in the first half hour. A positive significant correlation was found between IL-6 levels and pulmonary, cardiopulmonary and renal dysfunction in the early postoperative period. Also, there was a relationship between IL-8 levels and hematological dysfunction. The development of these studies may be valuable in developing medical treatment protocols that will prevent inflammatory systemic responses. |
4. | Extracorporeal Cardiopulmonary Resuscitation in Pediatric Cardiac Patients: A Single-center Experience Murat Çiçek, Emine Hekim Yılmaz doi: 10.14744/GKDAD.2024.69782 Pages 139 - 144 Objectives: Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to increase survival rates after in-hospital pediatric cardiac arrest. The aim of this study was to describe our experience with ECPR in pediatric cardiac patients. Methods: We performed a retrospective analysis of our experience from a single institution with 54 patients who underwent ECPR between 2016–2024. The endpoint of the study was survival to discharge. Results: Twenty-seven patients (50%) were female, and the median age at the time of ECPR was 5 months (IQR, 0.7–23 months). Seventeen (31.5%) of the patients were neonates, and 44 patients (81.5%) had biventricular physiology. Forty-eight patients (88.8%) underwent open chest cannulation, and 6 patients (11.2%) underwent peripheral cannulation. There were 24 survivors (44.4%) and 30 (55.6%) non-survivors after ECPR. Forty-four of the patients were postoperative (81.5%), and 23 of them survived. The survival rate in postoperative patients (52.3%) was significantly higher than in non-postoperative patients (10%) (p=0.015). Forty-five patients (83.3%) had cardiac arrest in the intensive care unit (ICU), and the survival rate was significantly higher in ICU cardiac arrest patients (51.1% vs. 11.1%, p=0.029). The survival rate without neurological sequelae was 31.4%. The median duration of ECMO support was 5 days (IQR, 2–8 days). Conclusion: Extracorporeal cardiopulmonary resuscitation is a vital application in pediatric cardiac patients. Patients who had cardiac arrest in the ICU had better outcomes than non-ICU patients (p=0.029). Survival rates of postoperative patients were found to be better than those of non-postoperative patients (p=0.015). |
5. | Evaluation of Driveline Infections in Diabetic Patients with Left Ventricular Assist Devices Zeynep Ece Demirbaş, Mutlu Şeyda Öcalmaz, Gözde Tekin, Murat Sargın doi: 10.14744/GKDAD.2024.72324 Pages 145 - 150 Objectives: Left ventricular assist devices (LVADs) are critical in advanced heart failure management, yet driveline infections remain a significant complication. This study aimed to evaluate the microbiological profile and clinical outcomes of driveline infections in diabetic and nondiabetic LVAD patients. Methods: We conducted a retrospective analysis of 40 LVAD patients with driveline infections between January 2020 and December 2024. Microorganisms were categorized as gram-positive, gram-negative, or fungal agents, and their prevalence was compared between diabetic and nondiabetic groups. Clinical outcomes, including recurrence, bacteremia, and mortality, were analyzed. Results: Gram-positive bacteria were the most commonly isolated microorganisms in both diabetic (53.2%) and nondiabetic (63.6%) groups, with no statistically significant difference (p=0.285). Staphylococcus aureus was more frequently isolated in nondiabetic patients (25% vs. 12.9%, p=0.110). Gram-negative bacteria and fungal agents were identified in 35.8% and 6.6% of cases, respectively, with similar distributions across groups. Mortality was primarily influenced by age (AOR: 0.879, 95% CI: 0.789-0.979, p=0.019), while other demographic and clinical factors showed no significant associations. Conclusion: The microbiological profile of driveline infections in diabetic and nondiabetic LVAD patients is comparable, with minor differences in pathogen prevalence. Age was a significant independent risk factor for mortality, whereas diabetes did not contribute to differences in clinical outcomes. Larger, prospective studies are needed to validate these findings and optimize infection management strategies. |
6. | Does Age Change the Risks Leading to Bloodstream Infections in the Intensive Care Unit? Bülent Kaya, Suzan Şahin, Elif Bombacı, Serap Demir Tekol doi: 10.14744/GKDAD.2024.99907 Pages 151 - 156 Objectives: A significant correlation exists between bloodstream infections (BSI) in intensive care units (ICU) and morbidity, mortality, and healthcare costs. The objective of our study was to investigate risk analysis as a means of preventing BSI. Methods: A total of 183 (1.57%) patients diagnosed with BSI were included in the study. Risk analysis was performed by comparing patients over 65 years of age with patients under 65 years of age. Epidemiological data, Glasgow Coma Scales, APACHI-II, expected mortality rates, number of days of hospitalization, C-reactive protein (c-RP), procalcitonin (PRC), microorganism strains, mean days of infection, and mean days of mortality were distributed to both groups. Significant differences facilitating the occurrence of infection were searched. A p-value<0.05 was considered significant. Results: A total of 232 microorganisms were isolated. There were 79 (43.2%) female patients. 102 (55.7%) patients were over 65 years of age. The most common diagnoses among patients were sepsis (14.7%), aspiration pneumonia (13.1%), and COVID-19 (4.9%). The most common comorbidities were diabetes mellitus, hypertension, and cerebrovascular diseases. The expected mortality was 64.53±21.31 in the group under 65 years of age and 64.01±19.57 in the group over 65 years of age. The most commonly isolated microorganisms are A.baumannii (16.38%), Enterococci (14.22%), C.albicans (12.5%), and K.pneumonia (12.07%). Days to infection and mortality were also analyzed between the groups. Conclusion: No risk factors were identified for BSI. The risk can be reduced by a well-functioning surveillance network, continuous education, and compliance with standard isolation precautions. |
CASE REPORT | |
7. | Protamine Sulfate Infusion's Rare Side Effect: Severe Hypertension, Tachycardia Buket Özyaprak, Gürcan Güler, Tuğba Onur, Filiz Ata, İbrahim Burak Şeker, Hande Gürbüz, Nail Kahraman doi: 10.14744/GKDAD.2024.68725 Pages 157 - 160 Protamine sulfate is an agent used to antagonize the anticoagulant effect of heparin. Some side effects may occur during the administration of this agent. The most common side effects are hypotension, bradycardia, pulmonary vasoconstriction, and hypoxemia. However, hypertension and tachycardia may also occur, albeit rarely. Here, we present a case in which hypertension and tachycardia developed during protamine sulfate infusion in open-heart surgery. |
8. | Detection of Incidental Tracheal Bronchus in Minimally Invasive Cardiac Surgery Planned for Single Lung Ventilation Rahime Güney, Zeliha Aslı Demir, Nevriye Salman, Ümit Karadeniz doi: 10.14744/GKDAD.2024.90377 Pages 161 - 163 The tracheal bronchus is a rare congenital anomaly resulting from an additional tracheal outgrowth in the early stages of embryonic life. It typically arises from the right wall of the trachea above the carina. Generally asymptomatic, it may sometimes lead to lung disease. We present the case of a 70-year-old male scheduled for minimally invasive valve surgery, where an accessory bronchus was incidentally detected during single-lung ventilation. |
9. | Reviewer List Page 164 Abstract | |