Objective: This study aimed to investigate the prognostic value of the preoperative Inflammatory Prognostic Index (IPI) in predicting late mortality in patients undergoing isolated surgical aortic valve replacement (AVR). Methods: A retrospective, single-center cohort of 400 patients who underwent elective, isolated surgical AVR between 2015 and 2023 was analyzed. The IPI was calculated using the formula: C-reactive protein (CRP) × neutrophil-to-lymphocyte ratio (NLR) / albumin. Patients were stratified into low- and high-IPI groups based on an optimal cut-off value of 0.2588 determined via ROC analysis. Clinical characteristics, operative data, and outcomes were compared. Cox proportional hazards regression was used to identify independent predictors of late mortality. Results: Patients with high IPI scores (≥0.2588) had significantly increased late mortality compared to those with low IPI (<0.2588) (10.3% vs 2.3%, p < .001). High IPI was associated with elevated CRP and neutrophils, and reduced albumin and lymphocytes. In univariate analysis, age, bioprosthesis use, and high IPI were significantly associated with late mortality. However, in multivariate analysis, only high IPI remained an independent predictor (HR = 3.405, 95% CI: 1.289–8.996, p = .013). Kaplan–Meier survival analysis confirmed lower long-term survival in the high-IPI group ( log-rank p < .001). Conclusion: Preoperative IPI is a simple, accessible, and independent predictor of late mortality after surgical AVR. Integrating IPI into preoperative risk assessment may improve long-term prognostic stratification and guide perioperative management.

Background: This study aims to identify the causes of early mortality in patients undergoing mitral valve surgery performed in combination with coronary artery bypass grafting for the treatment of ischemic mitral regurgitation. Methods: Between January 2017 and January 2023, a total of 411 patients (272 males, 139 females; mean age: 63.1±9.1 years; range, 32 to 92 years) who underwent coronary artery bypass grafting and mitral valve surgery due to ischemic mitral regurgitation were retrospectively analyzed. The primary outcome measure of the study was in-hospital mortality. The patients were divided into two groups as those with and without in-hospital mortality. Variables affecting mortality were identified. Results: In-hospital mortality was observed in 13.6% (n=56) of the patients. Elective surgery was performed in 308 patients (74.9%), while priority surgery was performed in 103 patients (25.1%). Mortality rate was 9.1% in elective cases and 27.1% in priority cases. Independent risk factors for mortality included age (p=0.001), female sex (p<0.001), priority surgery (p=0.005), low left ventricular ejection fraction (p=0.005), high creatinine levels (p=0.002), the presence of extracardiac arteriopathy (p=0.042), and prolonged cardiopulmonary bypass time (p<0.001). In priority cases, a waiting period of ≤9 days was associated with higher mortality (area under the curve: 0.781, sensitivity: 75%, specificity: 72%, p<0.001). Conclusion: A comprehensive preoperative evaluation is crucial for optimizing outcomes in patients with ischemic mitral regurgitation. In high-risk cases, the use of less invasive approaches, such as percutaneous interventions, can be considered potential alternatives. In priority cases, if hemodynamic stability can be achieved, waiting nine days after the index event before performing surgical intervention may significantly reduce perioperative and in-hospital mortality rates.

The aim of this study is to compare the insertion sites of drainage tubes placed in the left thorax after elective coronary artery bypass grafting (CABG) surgeries. Patients were divided into two groups based on the site of tube insertion into the left hemithorax: those with a tube inserted from the subxiphoid region and those with a tube inserted from the left intercostal region. Comparative analyses between these two groups and factor analyses contributing to the outcome were performed. There were no significant differences observed in terms of age, gender, height, and weight among patients undergoing coronary artery bypass surgery based on the site of drain placement. Twelve patients (5.2%) required re-drainage procedures, with five (41.7%) for pneumothorax and seven (58.3%) for pleural effusion. Atelectasis was absent in 144 patients (62.1%) while present in 88 patients (37.9%). The frequency of atrial fibrillation (AF) was significantly higher in the group with intercostal drains. Additionally, pain scale scores were significantly higher in patients with intercostal drains. Path analysis revealed that the visual pain scale value played a full mediating role in the effect of the drain site on AF. The statistically significant occurrence of pain and higher rates of postoperative AF in patients with intercostal tube placement are noteworthy. We believe that in patients undergoing elective coronary artery bypass surgery, the drain placed in the left hemithorax should be inserted from the subxiphoid region, if there are no contraindications.

Objectives: Ischemic mitral valve regurgitation (IMR) is a subgroup of secondary mitral valve insufficiency that develops due to ischemic heart disease. The aim of the study is to evaluate the patients who were operated after acute myocardial infarction (AMI) for the type of interventions to be performed for the mitral valve in terms of mortality and morbidity. Methods: Patients who were admitted to the hospital with the diagnosis of acute myocardial infarction and operated emergently or urgently between January 2017 and December 2020 were evaluated. Echocardiographic quantitative and qualitative data were measured. Accordingly, patients were evaluated as mild, moderate or severe mitral insufficiency. Patients who were found to have significant IMR (≥ moderate mitral regurgitation) in the early period and who could achieve complete revascularization were included in the study. Patients were divided into two groups whether the mitral valve was intervened or not. Results: The demographical data of the patients that were included in the study is as follows, 73.4% were male and 33% were female. The average age of the patients was 63.2±8.9. Patients were compared in terms of significant postoperative residual mitral regurgitation. 62.2% (n=23) of the patients undergone isolated CABG had mild mitral regurgitation. 5 patients with mitral valve annuloplasty (17.9%) had significant residual regurgitation (p<0.001). Conclusion: Mitral valve intervention should not be considered in non-severe mitral valve insufficiencies (without papillary rupture or chorda rupture) after AMI. The higher incidence of insufficiency after the use of isolated mitral annular ring due to left ventricular remodeling makes mitral annular ring less of a treatment option in the acute process.

Aim: Acute extremity ischemia (AEI) is a disease in which the arterial perfusion of the limb is suddenly reduced, mostly due to a thromboembolic condition. There is a need for an urgent evaluation and intervention, most commonly surgical embolectomy. Surgically removed thrombus materials can provide information about the disease and its process. Method: Patients who underwent embolectomy for acute extremity ischemia between November 2021 and March 2022 were retrospectively analyzed, and the obtained embolectomy materials were histopathologically evaluated. Results: We included 32 cases of patients who underwent embolectomy surgery for AEI. The histopathological evaluation of the materials taken from these cases determined that the thrombus age was compatible with the first 48 hours. Malignant epithelial tumor cells were detected in one case. In addition, we assessed and showed that re-intervention was significantly higher in cases with a high fibrin score with chronic peripheral artery disease. Conclusion: We believe that the histopathological evaluation of the materials removed from patients who underwent embolectomy surgery for acute extremity ischemia can aid in diagnosis, guide treatment, and provide valuable prognostic information.