Alper Özbakkaloğlu

Background: The Albumin–Bilirubin (ALBI) score is an easy-to-use, objective marker of liver synthetic function that has demonstrated prognostic value in various cardiovascular conditions. However, its role in predicting postoperative bleeding after CABG has not been previously investigated. Methods: Patients were divided into two groups according to their median preoperative ALBI score (−2.97): Low ALBI (n = 78) and High ALBI (n = 79). The primary outcome was excessive postoperative bleeding, defined as cumulative drainage exceeding 1000 mL within the first 24 postoperative hours. Secondary outcomes included transfusion requirements, mechanical ventilation duration, and length of hospital stay. Correlation and regression analyses were performed to assess the relationship between the ALBI score and postoperative bleeding. Results: The High ALBI group demonstrated a significantly greater postoperative drainage volume (450 [350–700] mL vs. 350 [300–487.5] mL, p = 0.007), higher erythrocyte transfusion (p = 0.001) and fresh frozen plasma transfusion requirements (p = 0.034), and prolonged mechanical ventilation duration (p < 0.001) and hospital stay (p = 0.003) compared to the Low ALBI group. Spearman correlation analysis revealed a significant positive correlation between the ALBI score and drainage volume (rho = 0.272, p < 0.001), and thus the ALBI score was identified as a significant predictor of excessive postoperative bleeding exceeding 1000 mL (OR: 5.93, 95% CI: 1.63–21.60, p = 0.007). Conclusions: The preoperative ALBI score is an easy-to-use and readily available tool that may serve as an effective adjunct for identifying patients at an elevated risk of postoperative bleeding prior to isolated CABG.

Aim: Residual stenosis after superficial femoral artery (SFA) balloon angioplasty may adversely affect immediate procedural success and long-term patency. This study aimed to identify clinical, angiographic, and procedural factors associated with immediate residual stenosis following SFA balloon angioplasty performed according to a standardized balloon inflation protocol. Material and Methods: This retrospective single-center observational cohort study included 167 consecutive patients who underwent primary SFA balloon angioplasty between January 2024 and April 2026. All procedures were performed using routine predilatation followed by a standardized 2-minute balloon inflation protocol. Residual stenosis ≥ 30% on postprocedural digital subtraction angiography (DSA) was defined as a suboptimal immediate angiographic outcome. Clinical, angiographic, and procedural variables were evaluated, and independent predictors were identified using multivariable logistic regression analysis. Only Trans-Atlantic Inter-Society Consensus II (TASC II) A and B lesions were included. Results: Residual stenosis ≥ 30% was observed in 70 patients (41.9%). Compared with patients who achieved an optimal angiographic result, those with residual stenosis were older, had a higher prevalence of diabetes mellitus, and exhibited more severe preprocedural stenosis. Lesion length did not differ significantly between patients with residual stenosis < 30% and ≥ 30% (91.3 ± 21.8 mm vs 88.1 ± 20.4 mm; p = 0.333). Multivariable logistic regression demonstrated that increasing age (odds ratio (OR), 1.05; 95% confidence interval (CI), 1.01 – 1.09; p = 0.026), diabetes mellitus (OR, 2.67; 95% CI, 1.27 – 5.59; p = 0.009), and greater preprocedural stenosis severity (OR, 1.11; 95% CI, 1.06 – 1.15; p<0.001) were independently associated with residual stenosis. Lesion length was not an independent predictor (p = 0.344). The final prediction model demonstrated good discriminatory performance (area under the receiver operating characteristic curve (AUC) = 0.80). Conclusion: Advancing age, diabetes mellitus, and greater preprocedural stenosis severity were independent predictors of residual stenosis after standardized balloon angioplasty for TASC II A-B SFA lesions, whereas lesion length was not. Early identification of patients at increased risk of residual stenosis may facilitate individualized procedural planning and optimize immediate angiographic outcomes.

Impact of non-carotid peripheral artery disease on early outcomes after coronary artery bypass grafting: A meta-analysis - Cardiovascular Surgery and Interventions

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.

Objectives: Coronary artery bypass grafting (CABG) remains a fundamental surgical treatment for advanced coronary artery disease. With the increasing use of large language models to obtain health information, patients are increasingly turning to these systems to understand surgical options. However, their performance in generating patient-oriented CABG information has not been sufficiently evaluated. Therefore, this study aimed to compare the responses generated by ChatGPT and DeepSeek-R1 to patient questions about CABG in terms of scientific accuracy, comprehensibility, and level of unnecessary detail. Methods: Forty patient-oriented questions were developed based on online sources and clinical experience. Responses were obtained from ChatGPT and DeepSeek under standardized conditions. A blinded panel of four cardiovascular surgeons evaluated the responses using a five-point Likert scale across three domains. Statistical analyses were performed using paired tests. Results: DeepSeek generated significantly longer responses than ChatGPT (212.88 ± 48.13 vs. 188.7 ± 50.34 words; p < 0.001). Accuracy scores were higher for DeepSeek (median 4.5 vs. 4.25; p = 0.004), whereas comprehensibility and unnecessary detail scores were similar between the models. Overall scores were high for both models (4.32 ± 0.28 vs. 4.27 ± 0.30; p = 0.34). Conclusions: The responses generated by both models were generally evaluated favorably by the expert panel, with only limited differences observed between them. DeepSeek demonstrated higher accuracy, whereas ChatGPT tended to produce shorter and more concise responses. However, given the variability observed at the individual-question level, these findings should be interpreted with caution. Large language models may support patient information delivery but should not be considered reliable stand-alone sources for clinical decision-making or patient counseling.

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.

Objectives: This study aimed to evaluate pathological differences in aortic valve cusps from patients undergoing aortic valve replacement due to aortic stenosis. Patients and methods: In this single-blind observational study, aortic valves from 20 patients (10 males, 10 females; mean age: 69±6.36 years; range, 62-84 years) were divided into left coronary, right coronary, and noncoronary cusps between January 2013 and December 2014. The cusps were stabilized in 10% formalin and sent to the pathology lab in a blinded manner. Sections 5 µm in thickness were prepared, stained with hematoxylin-eosin and Van Gieson, and analyzed for inflammation, fibrosis, and calcification using light microscopy. Comparisons were made between right, left, and noncoronary cusps. Results: Inflammation comparisons between right, left, and noncoronary cusps showed no statistically significant differences (p=0.199, p=0.789, and p=0.379, respectively). For fibrosis, left and right coronary cusps and right and noncoronary cusps were not significantly different (p=0.079 and p=0.880); however, the comparison between left coronary and noncoronary cusps was significant (p=0.046). Regarding calcification, left and right coronary cusps and right coronary and noncoronary cusps showed no significant difference (p=0.285 and p=0.180), while the comparison between left coronary and noncoronary cusps was statistically significant (p=0.011). Conclusion: While pathological differences between aortic valve cusps are rarely emphasized in the literature, this study identified significant fibrosis and calcification differences in left coronary and noncoronary cusps. These findings could contribute to a better understanding of calcific aortic stenosis and potentially guide new treatments.