Sercan Tak

Background/aim: Pulmonary regurgitation following tetralogy of Fallot repair is a common long-term complication requiring pulmonary valve replacement. Injectable bioprosthetic valves offer a less invasive alternative to conventional surgical replacement, but comparative data in pediatric populations remain limited. This study aimed to evaluate short-term and long-term clinical outcomes of injectable pulmonary valve replacement and conventional pulmonary valve replacement in pediatric patients with severe pulmonary regurgitation following tetralogy of Fallot repair. Materials and methods: This retrospective study included 22 pediatric patients who underwent pulmonary valve replacement. Patients were divided into injectable (n = 9) and conventional (n = 13) groups based on anatomical criteria. Primary outcomes included early postoperative parameters and long-term valve function. The mean follow-up duration was 10.5 ± 2.5 years. Results: Favorable early outcomes were noted in the injectable pulmonary valve replacement cohort, including shorter intensive care unit stay (16.8 ± 6.2 vs. 37.0 ± 23.4 h, p = 0.021), reduced mechanical ventilation duration (5.2 ± 3.9 vs. 15.4 ± 11.4 h, p = 0.019), decreased chest tube drainage (206.7 ± 108.2 vs. 513.1 ± 274.1 mL, p = 0.005), and shorter hospital stay (5.4 ± 2.4 vs. 8.4 ± 3.1 days, p = 0.026). Long-term outcomes indicated similar valve function and right ventricular remodeling in the two groups, with excellent freedom from reintervention (100%) during follow-up. Conclusion: Injectable pulmonary valve replacement appears to be a safe alternative, offering favorable early outcomes and long-term valve performance comparable to conventional methods. However, clinical experience and precise patient selection remain critical for achieving optimal results.

Introduction: Nosocomial infections (NIs) following cardiac surgery in children with congenital heart disease (CHD) remain a significant contributor to morbidity, mortality, and prolonged hospital stays. This study aimed to identify independent risk factors for NI and to evaluate the predictive utility of the Systemic Immune-Inflammation Index (SII) in this high-risk population. Material and methods: This was a single-center, retrospective observational study involving patients who underwent cardiovascular surgery between January 2015 and March 2025 and remained hospitalized for > 48 h. NI was defined based on the Center for Disease Control's National Healthcare Safety Network (CDC/NHSN) criteria. Multivariate logistic regression analysis using the ‘backward conditional’ method was performed to determine independent predictors of NI. Baseline and postoperative SII were calculated. Results: A total of 209 children were included in the study. NIs were observed in 46 patients (22.0%), with sepsis (69.6%) and pneumonia (30.4%) being the most frequent types. Gram-negative bacteria (58.4%) predominated. Patients with NI were significantly younger, more frequently had cyanotic CHD, comorbidities, and higher Aristotle scores. Univariate analysis showed that postoperative SII was significantly lower in the infection group (562.73 vs. 916.28; p < 0.001). However, multivariate analysis identified four independent predictors of increased NI risk; younger age (risk decreased by 2.2% per month: OR = 0.978, 95% CI = 0.957–0.999, p = 0.041), mechanical ventilation duration (risk increased by 1.2% per hour: OR = 1.012, 95% CI = 1.00–1.024, p = 0.047), postoperative length of stay (LOS) (risk increased by 16.2% per day: OR = 1.162, 95% CI = 1.031–1.309, p = 0.014), and presence of postoperative complications (risk increased∼110-fold: OR = 110.365, 95% CI = 8.042–1514.674, p < 0.001). Postoperative SII did not retain a strong independent predictive value in the multivariate model. Discussion: Postoperative complications are the strongest independent predictor for NIs following pediatric cardiac surgery. Prolonged mechanical ventilation and postoperative LOS significantly increase this risk. While SII correlates with infection status negatively, it does not function as a robust independent predictor in this patient population, possibly due to the overwhelming inflammatory response induced by cardiopulmonary bypass. These findings underscore the need for stringent infection control and aggressive management of postoperative morbidity.

Aim: This study aims to compare the early- and mid-term outcomes of modified single-patch and double-patch techniques for complete atrioventricular septal defect (AVSD) repair. We hypothesized that the modified single-patch technique offers similar or superior efficacy while reducing surgical complexity.Materials and Methods: We conducted a retrospective analysis of 66 patients who underwent complete AVSD repair between January 2006 and December 2019. Patients were stratified into two groups based on the surgical technique: Modified Single-Patch (Group 1, n=45) and Double-Patch (Group 2, n=21). Demographic data, intraoperative parameters (aortic cross-clamp and cardiopulmonary bypass times), early morbidity-mortality, and mid-term echocardiographic results were assessed.Results: The double-patch group had significantly longer aortic cross-clamp (71 vs. 48 minutes, p < 0.001) and cardiopulmonary bypass durations (91 vs. 68 minutes, p < 0.001). While early mortality did not differ significantly between groups, pulmonary complications were significantly more frequent in the double-patch group (42.9% vs. 13.3%, p = 0.01). At mid-term follow-up (median 8 years), the double-patch group exhibited significantly higher rates of residual ventricular septal defects (23.8% vs. 2.2%, p = 0.011) and severe left atrioventricular valve insufficiency (19.0% vs. 6.7%, p = 0.025).Conclusion: Our findings indicate that the modified single-patch technique reduces surgical times, decreases residual defect rates, and better preserves left atrioventricular valve function in anatomically suitable cases. This technique stands out as a preferable surgical approach to mitigate long-term adverse outcomes.

The impact of vasoactive inotropic score values on mortality and ECMO-related complications in children - Turkish Journal of Thoracic and Cardiovascular Surgery

Aim: In our study, we aimed to comparatively examine the effect of HbA1c levels and diabetes disease on patients undergoing isolated coronary bypass surgery. Material and Methods: 200 consecutive patients (152 male, 48 female, mean age 61.1) who underwent coronary artery bypass surgery (CABG) in our hospital were included in the study. The patients were divided into two groups. Group 1 consisted of patients with HbA1c ≥6.5 % (n=100) and group 2 consisted of patients with HbA1c 7.65% was the threshold value for occurrence of mediastinitis with a sensitivity of 80% and specificity of 65.6%. Conclusion: As a result, poor control of blood glucose levels following CABG is a risk factor for infection and HbA1c is a significant marker for identification of preoperative infection risk.

Introduction: This study aims to assess the predictive efficacy of the modified Frailty Index for 30-day postoperative outcomes in elderly patients undergoing vascular surgery and to evaluate its additional value compared with conventional tools. Materials and Method: This retrospective cohort study examined 155 consecutive patients aged ≥ 65 years who underwent elective vascular surgery. The preoperative 11-item modified Frailty Index was calculated using National Surgical Quality Improvement Program variables. The primary endpoint was 30-day mortality, and secondary endpoints included surgical site infection, myocardial infarction, septic shock, reintubation, stroke, and acute kidney injury. Results: The mean age was 71.98 ± 5.59 years. The 30-day mortality rate was 16.8%. The modified Frailty Index was higher in non-survivors than in survivors (3.96±1.48 vs 1.96±1.11, p<0.001) and showed excellent mortality prediction (Area Under the Curve=0.851, 95% CI: 0.778-0.924), with a threshold of 2.5 (sensitivity 84.6%, specificity 73.6%). In the multivariate analysis, adjusting for age, sex, American Society of Anesthesiologists score, and Geriatric Nutritional Risk Index, the modified Frailty Index remained associated with mortality (adjusted OR=2.79, 95% CI, 1.52-5.13; p=0.001). Each point increase correlated with higher risk of surgical site infection (OR=1.55, 95% CI: 1.19-2.03, p=0.001), myocardial infarction (OR=2.46, 95% CI: 1.27-4.78, p=0.008), septic shock (OR =2.46, 95% CI: 1.27-4.78, p=0.008), reintubation (OR=2.70, 95% CI: 1.82-4.02, p<0.001), and renal failure (OR=2.05, 95% CI: 1.43-2.94, p< 0.001). Conclusions: The 11-item modified Frailty Index predicted adverse outcomes in geriatric vascular surgery patients. Its use in risk stratification may improve perioperative management. Keywords: Frailty; Vascular Surgical Procedures; Geriatrics; Risk Assessment; Mortality

Objective: This study aimed to compare early- to mid-term outcomes of injectable biopulmonic valve replacement without cardiopulmonary bypass and conventional pulmonary valve replacement in patients with severe pulmonary regurgitation following tetralogy of Fallot (TOF) corrective surgery. Methods: The study was conducted with 22 patients between ?? 2011 and ?? 2020. Injectable pulmonary valve replacement was performed in nine patients, while 13 patients underwent bioprosthetic aortic valve replacement using a conventional surgical approach. An injectable valve was chosen for patients with a pulmonary annulus diameter ≤30 mm and ≥15 mm when there was no need for additional procedures. Results: Comparing postoperative outcomes between the injectable valve group and the conventional surgery group, the mean duration of intensive care unit stay was 16.78±6.22 vs. 37.00±23.43 h (p=0.003); the mean postoperative mechanical ventilation time was 5.22±3.93 vs. 15.38±23.43 h (p=0.001); the mean volume of chest tube drainage was 206.67±108.16 mL vs. 513.08±274.11 mL (p=0.003); the mean inotropic score was 5.00±5.59 vs. 10.96±8.98 (p=0.05); the mean vasoactive score was 6.11±8.20 vs. 12.11±10.40 (p=0.04); and the mean length of hospital stay was 5.44±2.35 vs. 8.38±3.09 days (p=0.04). Conclusion: Injectable pulmonary valve replacement, which can be applied without cardiopulmonary bypass, has advantages such as being less invasive and having better postoperative results compared to the conventional procedure. However, more comprehensive studies with long-term results are needed.

We aimed to investigate the antiplatelet drug resistance utilizing light transmission-lumiaggregometry (LT-LA) and platelet function analyzer-100 (PFA-100) in patients undergoing cardiovascular surgery. The study included 60 patients diagnosed with stable coronary artery disease and peripheral vascular diseases that required surgery. The participants were divided into three groups: patients receiving Aspirin (ASA) (n=21), patients receiving Clopidogrel (CLO) (n=19), and patients receiving dual therapy (ASA+CLO) (n=20). Aggregation and secretion tests in LT-LA and closure time in PFA-100 were used to measure antiplatelet drug resistance. Based on the ADP-induced aggregation test, 43% of patients were resistant to ASA, 22% to CLO, and 15% to dual therapy. Diabetes, hypertension, and hyperlipidemia were the most commonly identified comorbid disorders. In patients with comorbid risk factors, the median value of platelet aggregation response to ADP was significantly higher in the ASA group than in the CLO and dual therapy groups (p=0.0001). In patients receiving ASA monotherapy, the maximum amplitude of aggregation response to platelet agonists was equal to or more than 70% in 43% of patients for ADP and 28% for collagen in LT-LA. Elevated ADP (≥0.29 nmol) and collagen (≥0.41 nmol)-induced ATP release were found in 66% of patients utilizing ADP agonist and 80% of patients using collagen agonist undergoing ASA therapy in LT-LA. Closure times in PFA-100 were normal in 28% of patients using collagen-ADP cartridges and 62% of patients using collagen-epinephrine (CEPI) cartridges who received ASA. Recurrent thrombosis and bleeding were observed in 12 (20%) of patients with cardiovascular disease. Three of these individuals (25%) showed ASA resistance, which showed normal response to ADP-induced aggregation (≥70%) and secretion (≥0.29 nmol), as well as normal CEPI closure times. Our findings suggest that antiplatelet drug monitoring with LT-LA and PFA-100 may be useful in high-risk and complicated cardiovascular patients.

Aim: To reveal the coping attitudes of mothers of children who had undergone surgery to diagnose congenital heart diseases and the relationship between these attitudes and depression levels. Material and Methods: This study was a cross-sectional observational descriptive study conducted in a pediatric cardiovascular surgery clinic. The study included 32 mothers of pediatric patients who were surgically treated for congenital heart diseases. Participants were assessed with sociodemographic information form, Turkish versions of the coping orientation to problems experienced inventory (COPE), and the Beck depression inventory (BDI). Results: The median maternal age was 31.0 (range, 21-47) years. The median BDI score was 11 (range, 1-27), and the number of mothers with a BDI score of 17 and above was 13 (40.6%). Problem-focused coping was the most common problem-coping style used by 29 (90.6%) participants with a median score of 67.0 (range, 41.0-72.0). In addition, 10 (31.3%), 10 (31.3%), and 9 (28.1%) participants showed the highest scores for active coping, suppression of competing activities, and seeking instrumental social support subscales, respectively. There was a negative correlation between BDI score and active coping, restraint, seeking instrumental social support subscales, and problem-focused coping total scores. Conclusion: Our study revealed that most mothers of children with CHD used problem-focused coping more frequently. There was a negative correlation between the problem-focused coping attitude total score and the Beck Depression total scores. Interventions to target problem-focused coping could potentially protect mothers from depression.