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Management of type II endoleak after EVAR: Risk assessment and surveillance - Turkish Journal of Thoracic and Cardiovascular Surgery

Background: This study aims to investigate the effects of deep parasternal intercostal plane block on left internal thoracic artery vasospasm in coronary artery bypass grafting patients. Methods: Between March 2024 and August 2024, a total of 29 patients (24 males, 5 females; mean age: 60.1±8.3 years; range, 56 to 66 years) who were scheduled for elective coronary artery bypass grafting were included in this prospective study. An ultrasound-guided bilateral deep parasternal intercostal plane block was performed with 15 mL of 0.25% bupivacaine per side after anesthesia induction. Left internal thoracic artery peak systolic velocity, end-diastolic velocity, and resistive index, along with heart rate and mean arterial pressure, were recorded immediately before the block (T0) and 30 min after (T1). Demographics, body mass index, and comorbidities of the patients were noted. Results: After deep parasternal intercostal plane block administration, the left internal thoracic artery resistivity index decreased significantly (p=0.041), and the left internal thoracic artery diameter increased significantly (p=0.004). Although the peak systolic velocity increased and the end-diastolic velocity decreased following the block, these changes were not statistically significant (p=0.145 and p=0.135, respectively). Conclusion: Our study findings suggest that deep parasternal intercostal plane block administration may prevent left internal thoracic artery vasospasm by increasing arterial conduit diameter and reducing the resistivity index. Based on these findings, we believe that this method can be safely applied under ultrasound guidance without complications.

Aim: To assess the benefit of a modified sternal closure (Figure-of-eight and double-loop sternal-closure, FUSION) versus conventional figure-of-eight wiring (FEW) technique in reducing sternal instability in obese patients undergoing coronary artery bypass grafting (CABG). Material and Methods: We retrospectively analyzed 90 obese (body mass index ≥30 kg/m²) patients who underwent elective isolated CABG under median sternotomy between January 2023 and January 2024 at the Ankara Bilkent City Hospital. Patients were divided into two groups based on the sternal closure technique employed: 48 patients in the FEW groups and 42 patients in the FUSION group. Clinical follow-ups were conducted for two months postoperatively, and sternal instability was assessed through clinical examination, chest X-rays, and thoracic CT scans when necessary. Results: Demographic and perioperative variables were similar among groups. Sternal instability occurred more frequently in patients in the FEW group (10.4%) than in those in the FUSION group (2.3%; p =0.001). Multivariate analysis showed that FEW technique (OR: 3.5; 95% CI: 2.4-5.3; p = 0.001), COPD (OR: 3.5; 95% CI: 2.2-4.4; p = 0.05), DM (OR: 2.3; 95% CI: 1.3-4.1; p = 0.05), postoperative delirium (3.2; 95% CI: 2.1-4.8; p = 0.01) and female gender (OR: 2.4; 95% CI: 1.8-5.5; p = 0.02) were all independent factors for sternal instability. Conclusion: The FUSION technique significantly reduced sternal instability in obese patients compared to the FEW techniques, indicating its potential as an effective preventive measure for high-risk populations.

Background: This study aimed to investigate the performance of two versions of ChatGPT (o1 and 4o) in making decisions about coronary revascularization and to compare the recommendations of these versions with those of a multidisciplinary Heart Team. Moreover, the study aimed to assess whether the decisions generated by ChatGPT, based on the internal knowledge base of the system and clinical guidelines, align with expert recommendations in real-world coronary artery disease management. Given the increasing prevalence and processing capabilities of large language models, such as ChatGPT, this comparison offers insights into the potential applicability of these systems in complex clinical decision-making. Methods: We conducted a retrospective study at a single center, which included 128 patients who underwent coronary angiography between August and September 2024. The demographics, medical history, current medications, echocardiographic findings, and angiographic findings for each patient were provided to the two ChatGPT versions. The two models were then asked to choose one of three treatment options: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or medical therapy, and to justify their choice. Performance was assessed using metrics such as accuracy, sensitivity, specificity, precision, F1 score, Cohen's kappa, and Shannon's entropy. Results: The Heart Team recommended CABG for 78.1% of the patients, PCI for 12.5%, and medical therapy for 9.4%. ChatGPT o1 demonstrated higher sensitivity in identifying patients who needed CABG (82%) but lower sensitivity for PCI (43.7%), whereas ChatGPT 4o performed better in recognizing PCI candidates (68.7%) but was less accurate for CABG cases (43%). Both models struggled to identify patients suitable for medical therapy, with no correct predictions in this category. Agreement with the Heart Team was low (Cohen's kappa: 0.17 for o1 and 0.03 for 4o). Notably, these errors were often attributed to the limited understanding of the model in a clinical context and the inability to analyze angiographic images directly. Conclusion: While ChatGPT-based artificial intelligence (AI) models show promise in assisting with cardiac care decisions, the current limitations of these models emphasize the need for further development. Incorporating imaging data and enhancing comprehension of clinical context is essential to improve the reliability of these AI models in real-world medical settings.

Aim: This study aims to investigate the effects of topically applied tranexamic acid (TXA) on postoperative complications at the saphenous vein graft site following coronary artery bypass grafting (CABG).Material and Methods: A prospective analysis was conducted on 63 patients who underwent CABG between January 2024 and August 2024. Patients were randomly divided into two groups: a TXA group (n=32) who received topical TXA at the saphenous vein incision site, and a control group without TXA (n=31). Outcomes evaluated included leg circumference measurements, incidence of hematoma, ecchymosis, inflammation, necrosis, surgical infection, and mobilization difficulty. Pain and quality of life were assessed using the Visual Analog Scale (VAS) and Venous Clinical Severity Score (VCSS) respectively.Results: Patients in the TXA group exhibited significantly lower leg circumference measurements postoperatively on days 1 and 5 (p<0.05). The incidence of severe ecchymosis was significantly lower in the TXA group (3%) compared to (29%) the control group (p=0.001). No statistically significant differences were observed between groups for hematoma, inflammation, or necrosis rates. Hospitalization duration was shorter in the TXA group (4.2±1.8 days) than in the control group (5.6±2.2 days, p=0.02). The TXA group also showed lower VAS pain scores and improved VCSS quality of life scores compared to the control group (p<0.05).Conclusion: Topical application of TXA at the saphenous vein incision site appears to reduce postoperative complications such as ecchymosis and leg swelling, while also improving pain management and quality of life. TXA may help shorten hospital stays and promote early mobilization following CABG. Further large-scale randomized controlled trials are needed to validate these findings and assess TXA’s impact on more severe complications such as hematoma and necrosis.