Objective: The left heart bypass is currently the most frequent adjunct to provide distal aortic perfusion during aortic clamping. However, closed-circuits cannot respond to sudden hemodynamic fluctuations during aortic clamping which may lead to complications. In this report, we aim to give the technical aspects of reservoir-added centrifugal pump circuit system, its implementation and the clinical outcomes. Methods: Between 2002 and 2020, the data of 35 patients underwent aortic aneurysm repair with the use of modified pump circuit were analyzed. The mean age was 53.4 years (range 24-73) and 91.4% of all was male. Preoperative demographics, intraoperative pump data and postoperative clinical outcomes were reported. Results: Thoracoabdominal incision was used in 22 patients (62.9%) and cerebrospinal fluid (CSF) drainage catheter was placed in 15 patients (42.9%). The left inferior pulmonary vein for outflow and the left femoral artery for inflow cannulation were used preferably. Median duration of pump support was 50 mins (13-121) in the cohort. The median transfusion of red packed cells was 2 units. Renal failure was observed in two patients and permanent paraplegia in one patient. Only one patient died in the elective group (1/34) and one patient in the emergent. Conclusions: The reservoir-added centrifugal pump is an effective, practical, and flexible perfusion system which should be in the armamentarium of surgeons in order to solve difficult problems during open repair of descending and thoracoabdominal aortic aneurysms.

OBJECTIVES: Mitral annular disjunction is a recognized risk factor for malignant ventricular arrhythmias in patients with mitral valve prolapse. This study aimed to evaluate the impact of mitral valve surgery on the burden of supraventricular and ventricular ectopic activity in patients with mitral annular disjunction. METHODS: Data from 32 patients who underwent mitral valve surgery between 2017 and 2024 were retrospectively analysed. The primary end-point was the change in the burden of supraventricular and ventricular ectopy following surgery. The secondary end-point was to assess whether this change differed according to the extent of the mitral annular disjunction distance. RESULTS: The mean age of the patients was 38.8 ± 14 years, and 53.1% were female. The vast majority (96.9%) underwent successful mitral valve repair. The mean cardiopulmonary bypass and aortic cross-clamp times were 133.3 ± 38 min and 95.8 ± 32 min, respectively. Postoperatively, the mean burden of supraventricular ectopy decreased from 13.8% to 3.7%, and ventricular ectopy burden decreased from 7.1% to 2.1%. Among patients with a mitral annular disjunction distance ≥8.5 mm, both supraventricular and ventricular ectopic activity significantly declined. In contrast, for those with a mitral annular disjunction distance <8.5 mm, a significant reduction was observed only in ventricular ectopy, with no statistically significant change in supraventricular ectopy. CONCLUSIONS: Mitral valve surgery is associated with a substantial reduction in both supraventricular and ventricular ectopic activity in patients with mitral annular disjunction. Furthermore, a mitral annular disjunction distance greater than 8.5 mm appears to be a predictor of a more pronounced reduction in arrhythmic burden following surgery.

Thoracic endovascular aortic repair (TEVAR) has been performed in the treatment of thoracic aortic disease since the mid-1990s. Complications associated with TEVAR are increasing rapidly due to its widespread use. One of these complications is late lethal aortoesophageal fistula (AEF). The aim of this study was to describe the diagnosis of AEF in a 64-year-old woman 8 months after TEVAR. The AEF was diagnosed on a computed tomography angiography with oral and intravenous contrast. The patient underwent open surgical repair and died of sepsis 12 days after surgery.

Amaç: Bu çalışmada Akut Aort Transeksiyonu tanısıyla 2002 – 2018 yılları arasında endovasküler tedavi ile tedavi edilmiş hastaların sonuçları ve başarıyı etkileyebilecek faktörleri sunmak amaçlanmıştır. Gereç ve Yöntem: Çalışmaya toplam 17 hasta dahil edilmiş olup retrospektif olarak planlanmıştır. Hastaların tüm verilerine dosyaları taranarak ulaşılmış ve tüm hastaların demografik verileri kaydedilmiştir. Çalışmaya dahil edilen tüm hastalardan yazılı onam belgesi alınmıştır. Hastaların travma şekilleri ve cinsiyet oranları yüzdelik olarak hesaplanmıştır. Kesin tanı için kontrastlı torakoabdominal bilgisayarlı tomografi çekilerek endovasküler tedavi açısından değerlendirme yapılmıştır. Endovasküler tedaviye uygun görülen tüm hastalara ilk 24 saat içinde müdahale edilmiştir. Bulgular: Çalışmamıza dahil edilen hasta grubunun evrelemesinde büyük çoğunluğu evre 4 hastalar oluşturmakta olup etiyolojide en büyük sebebin araç içi trafik kazaları olduğu göze çarpmaktadır. Çalışmaya dahil edilen 17 hastanın 2’si erken dönemde 1’i takip sürecinde kaybedilmiştir. Endovasküler tedavinin komplikasyonları olarak bilinen greftte migrasyon, psödoanevrizma ve greftte kıvrılma gibi komplikasyonlar ile karşılaşılmamıştır. On yedi hastanın 12’sinde sol subklaviyen arter kapatılmış olmasına rağmen sadece ikisine karotis – subklaviyen baypas uygulama ihtiyacı oluşmuştur. Sonuç: Konvansiyonel cerrahiye oranla endovasküler tedavinin düşük mortalite ile uygulanabiliyor olması akut aort transeksiyonlarında mortaliteyi azaltmaktadır. Müdahalenin ilk 24 saatte, bu konuda deneyimli merkezlerde yapılması ve greft seçiminde aort çapının %10’unun aşılmaması, balon dilatasyonundan kaçınılması tedavi başarısını etkileyen en önemli faktörlerdendir.

Background: Pediatric heart transplantation (HTx) is the standard therapy for end-stage heart failure in children, and the use of durable left ventricular assist devices (LVADs) as a bridge to transplant is increasing. However, comparative long-term data for LVAD-bridged versus directly transplanted pediatric recipients remain limited. In this study, we aimed to compare the early and long-term outcomes of pediatric heart transplantation with and without LVAD bridging. Methods: We retrospectively reviewed all pediatric patients who underwent orthotopic HTx at our institution between 2004 and 2024. 34 recipients were included, 17 bridged with durable LVAD support, and 17 transplanted without mechanical circulatory support. Perioperative characteristics, early postoperative complications, and long-term outcomes were compared between groups. Results: LVAD recipients had more advanced ventricular dysfunction, longer cardiopulmonary bypass and aortic cross-clamp times, and more frequent red blood cell transfusion requirements. Despite this higher-risk profile, early postoperative complications, early mortality, and ICU and hospital length of stay were similar between groups. Ten-year survival was 70.6% in the LVAD group, and 82.4% in the non-LVAD group (log-rank p = 0.365), and freedom from CAV and treated rejection did not differ significantly. Conclusions: In this single-center, two-decade experience, durable LVAD support enabled successful transplantation of high-risk pediatric candidates without compromising early or long-term post-transplant outcomes. LVAD bridging appears to be a safe and effective strategy in pediatric HTx.