Background: This study aimed to investigate the incidence of postoperative atrial fibrillation (POAF) in patients undergoing off-pump versus on-pump coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods: A total of 3,197 consecutive patients (1,816 males, 1,381 females; mean age: 60.8 ± 9.8 years) with preoperative sinus rhythm who underwent CABG at a cardiovascular surgery clinic between November 2009 and March 2014 retrospectively were analyzed. Of the patients, 1,680 underwent on-pump and 1,517 underwent off-pump cardiac surgery. Data, including demographic characteristics, preoperative risk factors, preoperative medications, laboratory test results, postoperative data and complications, and mortality and morbidity rates, were recorded. Results: According to the multivariate analysis, the type of operation, number of anastomoses, right coronary artery or right coronary posterior descending artery graft, vasopressor therapy (epinephrine, norepinephrine), operation duration, age >60 years, hypertension, length of hospital stay >4 days, and obstructive sleep apnea syndrome (OSAS) were the independent predictors of POAF after CABG. Our study results suggest that on-pump CABG under CPB is correlated with POAF. Conclusion: We recommend using off-pump CABG in select cases to minimize the risk of POAF.

OBJECTIVES Coarctation accompanied by cardiac lesions is a complex clinical situation due to the presence of two different pathologies that necessitate surgical treatment. An individual strategy, according to the severity of the disease, is important to reduce perioperative mortality and morbidity. METHODS We report here on 25 patients with coarctation accompanied by cardiac lesions who were treated by various surgical approaches. Coarctation and associated disease were treated in 14 patients in a single stage by an ascending-to-descending bypass (n = 11) or by a hybrid procedure (n = 3). The remaining 11 patients underwent a two-stage operation for their treatment. Six of these 11 patients who had coronary artery disease or signs of congestive heart failure were first operated for their cardiac disease, whereas in the remaining five patients, who did not have any congestive signs, coarctation repair was performed first. RESULTS All the patients were male, between the ages of 20 and 24 years, except for one 45-year-old woman. The mean cross-clamp times, cardiopulmonary bypass times and operation times were 52 ± 14.5, 102.3 ± 28.5 and 174 ± 24.8 min in the extra-anatomical bypass group; 29.8 ± 11.7, 55.5 ± 17.6 and 116 ± 22 min in the two-stage groups and 49 ± 19.8, 63 ± 18.7 and 159 ± 21.3 min in the hybrid patients, respectively. One patient who underwent extra-anatomical bypass died on the 14th postoperative day. There were no events during the follow-up period for the other patients. Also, there were no gradients between the extremities and no graft-related complications. CONCLUSIONS As a consequence of the progress in the development of endovascular techniques, hybrid treatment is becoming a more popular option for the treatment of coarctation accompanied by cardiac diseases. Two-stage procedures and extra-anatomical bypass might be alternative techniques if endovascular procedures are contraindicated or failing.

COVID-19 has been associated with the hypercoagulable state in the literature. Patients who are admitted to the hospital with severe COVID-19 may have some thrombotic complications. These patients have a high risk for venous and arterial thrombosis of large and small vessels. Here, a 42-year-old female with celiac artery thrombosis and splenic infarction after a history of mild COVID-19 was presented.

We read with interest the surgical approach of Yan et al. [1] to simple congenital heart defects. The right vertical axillary incision (RVAI) procedure decreased neither cardiopulmonary bypass time nor aortic cross-clamp and hospital stay. The authors claim that they had excellent results, achieving cosmetically satisfactory outcomes in young female patients. Although an objective multiple-choice questionnaire that focused attention on the auto-evaluation of the aesthetic result and its psychological influences has been reported previously [2], we could not understand how Yan et al. evaluated patient satisfaction. Meanwhile, it is not stated whether the subgroup analysis was made in terms of age and gender. This approach is recommended for its cosmetic advantages in young female patients, but adult patients in particular, might be dissatisfied regarding the incision of lateral breast tissue. Minithoracotomy with a submammarian incision can be specifically considered a more favourable approach. Contrary to the authors' comment, breast deformity or asymmetry or any cage deformity will not develop when a careful tissue approximation is performed by the elevation of the breast tissue in young or adult female patients [3, 4]. As stated by the authors, due to poor exposure of the operating field with the RVAI approach, the learning period of this technique will take longer than the other minimally invasive techniques. The conversion of the process into another approach such as an additional surgical incision, can be very difficult, may cause the sacrifice of the internal mammarian artery and may pulmonary complications and increase the magnitude of pain in the postoperative period as well.

Aim: In this study, we aimed to evaluate the results of endovenous N-Butyl Cyanoacrylate (NBCA) technique which is a non-tumescence endovenous ablation technique in patients with varicose veins.Material and Methods: A total of symptomatic 542 patients with single or bilateral saphenofemoral failure who presented to our center between April 2014 and August 2016 were included in the study. NBCA was applied to 657 lower extremities of 542 patients, 115 of whom were bilateral. The patients had C2, C3, C4, C5, C6 venous insufficiency according to CEAP classification. Vena saphena magna (VSM) diameter was at least 5.5 mm at the knee level, at least 6 mm at the saphenofemoral junction (SFJ) level, and reflux time was 2 seconds or longer.Results: The mean CEAP classification of 657 lower extremities was 3.1±0.6, the VSM diameter was 6.7±1.1 mm at the knee level, 8.3±2.1 mm at the SFJ, the procedure time was 15.2±2.9 minutes, and the hospital stay was 1.7±0.6 hours. At 6 months follow-up, only 7 (1.1%) partial recanalization of VSM, 1 (0.2%) deep vein thrombosis in the popliteal vein in the lower limb, and 9 (1.4%) thrombophlebitis in the distal 1/3 segment at over the knee of VSM healing with medical treatment. All of the procedures were completed without any complications.Conclusion: Newly developing techniques rapidly replace traditional methods and increase patient comfort. NBCA; It has become an effective method among endovenous ablation therapies with its technical advantages, high success rates in early and midterm.