SUMMARY OBJECTIVE: The aim of this study was to compare the accuracy, scientific quality, and clarity of responses generated by GPT-4o and Gemini to frequently asked patient questions related to carotid artery disease and carotid endarterectomy. METHODS: In total, 40 unique carotid endarterectomy-related questions were compiled from online sources and clinical experience. Each was entered into separate new sessions with GPT-4o and Gemini 2.5 Flash in Turkish, and responses were collected without modification. Notably, four blinded cardiovascular surgeons independently rated each answer (1–5 Likert scale) in three domains: Accuracy, Scientific Quality, and Clarity. Mean response lengths and domain scores were compared using appropriate paired tests. RESULTS: GPT-4o produced longer responses than Gemini (258.1±101.6 vs. 193.2±43.7 words; p<0.001). Overall, GPT-4o had higher Accuracy scores (4.33±0.39 vs. 4.16±0.33; p=0.04), with no significant differences in Scientific Quality or Clarity (p=0.377 and p=0.154, respectively). In rater-level analyses, Gemini scored higher in Clarity for one rater, whereas GPT-4o was superior in Accuracy and Scientific Quality for another. Overall mean scores were comparable (4.17±0.36 vs. 4.13±0.31; p=0.636). Physician referral was recommended in 62.5% of GPT-4o and 52.5% of Gemini (p=0.366). CONCLUSION: Both GPT-4o and Gemini provided "good"-quality responses to carotid endarterectomy patient questions, with GPT-4o showing a modest accuracy advantage, with no difference in other domains. Explicit disclaimers on both platforms underscore their supportive, not definitive, role in patient education. Physicians should remain the primary source for individualized decisions, and AI-generated information should always be verified.

Background and Objectives: Prolonged intensive care unit (ICU) stay following coronary artery bypass grafting (CABG) remains a major clinical challenge. The aim of this study was to identify preoperative and intraoperative factors that may predict prolonged ICU requirement in patients undergoing isolated CABG and to evaluate the impact of minimally invasive extracorporeal circulation (MiECC) utilization on this outcome. Materials and Methods: Patients who underwent isolated CABG between January 2024 and April 2025 were retrospectively analyzed. Prolonged ICU stay was defined as a postoperative intensive care duration exceeding 72 h. Predictors of prolonged ICU stay were evaluated using univariate logistic regression and four multivariable logistic regression models. Receiver operating characteristic (ROC) curve analyses were performed to assess the discriminative performance of significant and clinically relevant variables as well as the multivariable models. Results: A total of 82 patients were included and stratified into a prolonged ICU stay group (n = 32) and a non-prolonged ICU stay group (n = 50). The preoperative left ventricular ejection fraction (LVEF) was significantly lower (52.5% vs. 60%, p = 0.012) and preoperative leukocyte counts significantly elevated (8.4 vs. 7.97 × 10³/µL, p = 0.049) in the prolonged stay group. MiECC was employed in 28.1% of patients with a prolonged ICU stay and 30% of those with a non-prolonged stay (p = 0.530). Across four multivariable logistic regression models, lower preoperative ejection fraction and higher preoperative leukocyte count were identified as independent predictors of prolonged ICU stay, whereas MiECC utilization was not independently associated with this outcome. Conclusions: Lower preoperative ejection fraction and higher baseline leukocyte count were independently associated with prolonged ICU stay. No independent association between MiECC utilization and prolonged ICU stay could be demonstrated. These findings suggest that preoperative cardiac function and inflammatory status may contribute to ICU requirements following isolated CABG. Further prospective studies are warranted to validate these findings.

“Merkezimizde Sol Ana Koroner Stent İmplantasyonu Uygulanan Hastaların Major Advers Kardiyak Olaylar Açısından İncelenmesi” isimli çalışma hakkındaki düşüncelerim. Alper Özbakkaloğlu Özel Sağlık Hastanesi, İzmir/TÜRKİYE e-mail: alperozbakkaloglu@hotmail.com ORCİD: https://orcid.org/0000-0001-5735-4473 Sorumlu yazar: Alper Özbakkaloğlu Sorumlu yazar adres: Evka3 mah. 125/7 sok. Briçkent sitesi No:H3/1 Bornova, İzmir, TURKEY Sorumlu yazar telefon: +905309793335 Sayın Editör, Derginizde yayınlanan “Merkezimizde Sol Ana Koroner Stent İmplantasyonu Uygulanan Hastaların Major Advers Kardiyak Olaylar Açısından İncelenmesi” isimli makaleyi merakla okudum. Yazarların üzerinde durduğu konu günümüz Kalp ve Damar Cerrahisi ve Kardiyoloji girişimleri açısından oldukça önem arz etmektedir. Özellikle ana koroner lezyonlarında hasta morbiditesi ve mortalitesine etki edecek unsurların incelenerek ortak görüş oluşturulmasını çok değerli görüyorum. Makalede bahsedilen “Kalp Takımı” konseptinin 1 geliştirilerek, karar alma mekanızması haline getirilmesi gerçekten önem taşımaktadır. Makale ile ilgili iki konu hakkında görüş belirtme ihtiyacı hissettim. Öncelikle koroner arter hastalarında ana koroner lezyonu olması durumlarda hem 2018 ESC (European Society of Cardiology) 2 hem de 2021 AHA (American Heart Association) 3 klavuzlarında koroner bypass cerrahisini klas 1 endikasyon olarak belirtmektedir. Şahsi görüşüm bu klavuzlara atıfta bulunulması makaleyi daha kıymetli hale getirecektir. Diğer bir öneri olarak hastaların başvurularında CABG/PCI (Koroner Bypass Greftleme/perkütan koroner intervasyon) arasında nasıl karar verildiğinin aydınlatılması makaleyi daha üst bir pozisyona taşıyacaktır. Yazarlarında belirttiği gibi klopidogrel kullanımı farkı PCI öncesinde hastaya yükleme yapılmasından kaynaklanıyor ise karar aşamasının aydınlatılması bu farkında ortaya konmasını sağlayacağı kanaatindeyim. Yazarlara değerli çalışmalarından dolayı teşekkürlerimi sunuyorum. Özellikle Kalp takımı konseptinin geliştirilmesinin günümüz koşullarında son derece gerekli olduğu kanaatindeyim. Anahtar kelimeler: CABG, PCI, Sol ana koroner Referanslar 1. Çayırlı S, Eryılmaz U, Gülaştı S, Merkezimizde Sol Ana Koroner Stent İmplantasyonu Uygulanan Hastaların Major Advers Kardiyak Olaylar Açısından İncelenmesi, CBU-SBED, 2022, 9(4): 473-479 2. Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., ... & Zidar, J. P. (2022). 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(3), e18–e114. https://doi.org/10.1161/CIR.0000000000001038 3. European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS). (2018). 2018 ESC/EACTS Guidelines on Myocardial Revascularization. European Heart Journal, 40(2), 87–165. https://doi.org/10.1093/eurheartj/ehy394

Aim: With aging, there is a dramatic decrease in Vascular Endothelial Growth Factor (VEGF). The effects of plasma therapy applied to aged tissues have attracted attention in recent years, as young plasma is rich in rejuvenating factors that decrease in aged mice and support organ regeneration and hormone secretion. In the presented study, young plasma treatment was applied to aged rats and its effects on cellular proliferation and VEGF levels in the duodenum were evaluated. Material and Methods: For this purpose, aged male Sprague Dawley rats (24months, n=15) were treated with pooled plasma (0.5ml/day, intravenously for 30d) collected from young (5weeks, n=51) rats. Aged rats formed the control group while aged rats that received young plasma treatment were labelled as the experimental group. At the end of the experiment, the duodenums of the groups were collected and cell proliferation index and proliferation intensity were evaluated with proliferating cell nuclear antigen (PCNA) and expressions of VEGF which plays a role in both the digestive system and cardiovascular system were investigated. Results: VEGF expression intensity determined by immunohistochemical method showed an increase in experimental group (2.45±0.18) compared to control group (1.70±0.15) (p<0.001). Proliferation intensity showed a more severe immunoreaction in experimental group (2.35±0.19) compared to control group (1.20±0.08). Proliferation index was higher in experimental group (117.10±0.19) compared to control group (62.20±0.12). Conclusion: In our study, we propose a treatment approach that can prevent the aging-related decrease in VEGF, which is known to be important in many systems.