Objectives: The aim of this study was to investigate the potential of preoperative neopterin levels as a predictive marker for postoperative acute kidney injury (AKI) in patients undergoing on-pump cardiac surgery, in addition to other potential risk factors. Methods: This observational study included 91 patients who underwent elective cardiac surgery under cardiopulmonary bypass. Of these, 35 patients (38.46 %) experienced AKI following surgery, as outlined by the Kidney Disease Improving Global Outcomes (KDIGO) standards. The study participants were divided into two groups depending on whether they had developed AKI after the surgery or not. The study compared two groups and utilized logistic regression analysis to evaluate potential predictors. A receiver operating characteristic (ROC) analysis was conducted to determine the ability of preoperative neopterin levels to predict the occurrence of AKI. Results: A comparison of the baseline demographic, clinical, laboratory, and echocardiographic characteristics was conducted between patients who suffered from AKI and those who did not. The multivariate analysis demonstrated that EuroSCORE II (OR, 4.525; 95 % CI, 1.29–15.87; p=0.019), X-clamp time (OR, 1.157; 95 % CI, 1.01–1.326; p=0.035), and neopterin levels (OR, 22.952; 95 % CI, 3.14–167.763; p=0.002) were independently predicted the post-cardiac surgery AKI. ROC analysis identified a cut-off value of 9.65 nmol/L, which had a sensitivity of 91.4 % and a specificity of 91.1 % (area under the curve, 0.98; 95 % CI, 0.958–1; p<0.001). Conclusions: Our study emphasizes the potential of preoperative neopterin levels, EuroSCORE II, and X-clamp time as independent predictors of postoperative AKI, even in milder cases, in individuals undergoing on-pump cardiac surgery.

Pericardial cysts are rare benign lesions of the thoracic cavity and are mostly congenital anomalies. They are induced by an incomplete coalescence of foetal lacunae during the development of the pericardium. Pericardial cysts are usually unilocular, well marginated spherical or teardrop shaped and may be attached to the pericardium directly or by a pedicle. Of all pericardial cysts, 70 to 75% are located at the right cardiophrenic angle. We report a case that was incidentally diagnosed with only chest magnetic resonance imaging because of a paracardiac mass. In order to prevent complications, the giant pericardial cyst was excised outside of the pericardium with median sternotomy.

Median sternotomy is the most preferred approach in heart surgery. Post-sternotomy mediastinitis is a catastrophic and potentially life-threatening complication with an incidence rate of 0.15% to 5%, and its overall mortality rate reaches 47%. In this study, we aimed to compare the results of vacuum-assisted closure technique and the conventional methods on the management of mediastinitis following isolated coronary artery bypass graft surgery. Between February 2001 and July 2013, 32,106 patients who underwent cardiac operations were evaluated retrospectively. One hundred and fourteen patients who developed post-sternotomy mediastinitis were included in this study. The patients were divided into two groups and compared - vacuum-assisted closure group (n=52, 45.6%) and conventional treatment group (n=62, 54.4%). There were no differences between the two groups according to the patients’ characteristics, surgical data, and mediastinal cultures. However, we found that total treatment duration for post-sternotomy mediastinitis, time interval from diagnosis to negative culture, hospitalization time, and in-hospital mortality were statistically significantly lower in the vacuum-assisted closure group than in the conventional treatment group (P<0.001, P<0.001, P<0.001, and P=0.03, respectively). This study demonstrates that the vacuum-assisted closure technique improves the medical outcome of patients with post-sternotomy mediastinitis compared with the conventional treatment. The vacuum-assisted closure is a safe and more effective treatment modality for patients with post-sternotomy mediastinitis after cardiac surgery with reasonable morbidity and mortality.