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    eComment. Evidence-based selection of conduits in coronary artery bypass grafting
    (Oxford University Press, 2015) Özyüksel, Arda; Ersoy, Cihangir; Kayan, Ekin; Akçevin, Atıf
    We read with great interest the article by Gaudino et al. [1]. They have performed coronary artery bypass grafting (CABG) with both internal thoracic arteries (ITA) in a 68-year old patient with a surgical history of aortic coarctation repair. However, there Figure 2: Postoperative angiographic control showing normal functioning left (A) and right (B) ITA grafts. CASE REPORT M. Gaudino et al. / Interactive CardioVascular and Thoracic Surgery 279 Downloaded from https://academic.oup.com/icvts/article-abstract/20/2/279/734665 by guest on 09 April 2020 are some issues we would like to discuss regarding the surgical strategy of the graft selection in this patient. The patient was reported to be hypertensive, both at admission and during the postoperative period. The authors performed a histopathological evaluation of the discarded ITA segments and markedly thickened endothelium was encountered. We wondered how they had decided that the discarded distal segment of the ITA with markedly thickened endothelium guaranteed an intact proximal arterial wall. The atherosclerotic involvement of the ITA may be segmental, hence distal ITA sampling may not accurately predict the degree of atherosclerosis at the proximal part of the graft [2]. Moreover, the same authors had published a review on the use of ITAs in patients with aortic coarctation recently [3]. In that paper, they reviewed 13 reports related to this topic and only one of them included an angiographic control at the long-term follow-up. The authors concluded that, ’a careful evaluation of the conduit is obviously paramount in the context that preoperative transthoracic Doppler ultrasound and selective LITA and RITA catheterization at the time of cardiac catheterization will provide with optimal preoperative planning’.
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    EComment. Interpretation of the data together with the management of cardiac surgery patients with diabetes mellitus
    (Oxford Univ Press, 2013) Özyüksel, Arda; Ölmüşçelik, Oktay; Kayan, Ekin; Akçevin, Atıf
    We have read with interest the analysis by Tennyson et al. of the role of HbA1c in predicting the mortality and morbidity outcomes in patients undergoing coronary artery bypass surgery (CABG) [1]. In such patients, higher fasting blood glucose (FPG) levels are associated with a higher incidence of arrhythmia, atelectasis and prolonged mechanical ventilation, whereas higher HbA1c levels are associated with a higher incidence of intra-aortic balloon counterpulsation, massive bleeding and multi-organ failure [2]. Although diabetes mellitus (DM) is traditionally known to be associated with an increased risk for CABG, there are also adverse outcomes reported in the literature indicating similar hospital mortality rates for diabetic and non-diabetic patient groups [3]. In fact, delaying the surgical procedure seems to be the safest measure when quadrupled mortality for CABG is noted with HbA1c values of over 8.6% [1]. Since the lifespan of red blood cells is around three months, any effective change in HbA1c levels will be assumed to take place within 10-12 weeks. So, the question is about which parameters we are able to manipulate in a patient with altered FBG levels who are candidates for a CABG procedure and how we can interpret and evaluate the HbA1c and FPG levels in these patients. In our clinical practice we put all DM patients who are on oral hypoglycaemic drugs onto dual insulin treatment in the preoperative period without taking HbA1c levels into account.
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    Fibula allograft sandwich technique for the reconstruction of sternal nonunion after cardiac surgery
    (Elsevier, 2014) Ersoy, Cihangir; Özyüksel, Arda; Malkoç, Melih; Kayhan, Bekir; Kayan, Ekin; Akçevin, Atıf; Türko?lu, Halil
    Sternal dehiscence is an untoward complication of cardiac surgery that leads to increased morbidity as well as length of hospital stay and costs. Although many different conventional and creative techniques have been described using both synthetic and biologic materials, the ideal method of sternal reconstruction is still controversial. In this case, we describe a simple and reproducible "fibula allograft sandwich technique" for the reconstruction of sternal nonunion in a cardiac surgery patient. This technique also facilitates the conventional wiring by creating bilateral landing zones for the wires at both sides of the sternum.