Cardiovascular Surgery Clinic Research Articles

A Retrospective Analysis of Late Open Conversions Following Failed Endovascular Aneurysm Repair.

The incidence of late open surgical conversions (OSCs) has recently increased. Vascular surgeons face additional technical challenges in late conversion surgery of failed endovascular aneurysm repair (EVAR) due to the presence of a previously deployed endograft. Based on our institutional experience, this study aimed to delineate methods to improve late open conversion outcomes, proposing solutions for technical challenges. All preoperative OSC data on failed EVARs operated in our Cardiovascular Surgery Clinic between January 2017 and January 2024 were evaluated retrospectively. Study endpoints included early (30-day or in-hospital) and late follow-up outcomes. Early outcomes included perioperative mortality and morbidities, intensive care unit (ICU) period, and length of hospital stay (LOS). The main outcome of interest during follow-up was overall survival. Sixteen patients in our hospital, comprising eight elective and eight emergency procedures, underwent OSCs following EVAR. The difference between the 30-day mortality rates for the elective and urgent late conversions was significant (p < 0.001). Of these patients, 15 were male, with a mean age of 70.8 years (range: 62-80). Preoperative cardiac shock status and low hematocrit level (<20%) were independent mortality factors (p < 0.001). The ICU period was 8.7 ± 5.3 days (2-20 days) on average, and LOS was 17.3 ± 8.4 (6-29 days) days on average. The mean time to open surgical conversion in this cohort was 44.4 ± 16.8 months. The 5-year overall survival rate was 43.75%. The incidence of open surgical conversion is notably growing. Emergent open surgical conversions exhibit poorer mortality outcomes compared to elective procedures. Further data are essential to evaluate the ramifications of expanding the use of EVAR beyond the instructions for use (IFU) guidelines. The procedures involving patients who challenge the IFU criteria should be conducted at experienced centers and require close monitoring. Open surgical repair (OSR) as the initial treatment opportunity could be an alternative strategy for improving outcomes in this patient cohort.

Association between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery.

A combination of social inhibition and negative affectivity characterizes Type D personality. Type D, or distressed personality, is an established risk factor for the development and prognosis of coronary heart disease. It occurs in approximately 1 in 4 patients with coronary heart disease. This study aimed to investigate the relationship between Type D personality, illness perception, and coping strategies in patients undergoing open-heart surgery. This retrospective and cross-sectional study was conducted in a university hospital psychiatry and cardiovascular surgery clinics between February 2022 and April 2022. Seventy-one volunteered patients over the age of 18 who underwent open-heart surgery in the cardiovascular surgery clinic were included in the study. Cardiovascular surgeons recorded the sociodemographic and clinical data of the patients and referred them to the psychiatry clinic for further evaluation. Subsequently, patients underwent psychiatric evaluation and were assessed using the Type D Personality Scale, Coping Attitudes Assessment Scale, Hospital Anxiety and Depression Scale, and Illness Perception Questionnaire. According to this study, individuals with Type D personality tended to have higher scores on the Hospital Anxiety and Depression Scale. Analysis of the subdimensions of the Stress Coping Styles Scale revealed that individuals with Type D personalities showed a significantly lower optimistic approach and a considerably higher helpless approach. In terms of the subdimensions of the Illness Perception Questionnaire, it was found that individuals with Type D personality had a statistically lower treatment control approach and a statistically higher emotional representations approach. Identifying Type D personality traits in patients undergoing open-heart surgery can help manage negative illness perceptions through effective coping mechanisms.

The effect of preoperative training provided to patients undergoing coronary artery bypass graft surgery on postoperative comfort

Background/Aim: The most popular surgical procedure for treating coronary artery diseases is coronary artery bypass graft surgery. However, the comfort that patients experience after coronary artery bypass graft surgery varies considerably. The purpose of this study is to ascertain the impact of preoperative training on postoperative comfort in patients undergoing coronary artery bypass graft surgery. Methods: This study was conducted as a quasi-experimental research investigation the cardiovascular surgery clinic of Edirne Sultan Murat I State Hospital from December 2019 through December 2020. It included 46 patients aged 18–65 who were undergoing their first coronary artery bypass graft surgery and volunteered to participate. The patients in the experimental group (23 individuals), were provided preoperative training; no interventions were made with the patients in the control group. The General Comfort Questionnaire was administered to all of the patients prior to discharge. The necessary ethical and institutional approvals were obtained before the study. Transparent Reporting of Evaluations with Non-randomized Designs was used as the research reporting guideline. Results: The postoperative General Comfort Questionnaire total score (P&lt;0.001), mean scores of all sub-dimensions (P&lt;0.001) and comfort levels of the experimental group were higher than those of the control group (P&lt;0.001). Preoperative training therefore had a positive impact on postoperative comfort level. Conclusion: Preoperative training provided to patients improved their postoperative comfort. It is recommended that surgical nurses increase patient comfort by providing patient training before coronary artery bypass graft surgery and that nurses should be supported in administering patient training.

The effect of informing patients with video before cardiac surgery on intensive care experience: A randomized controlled trial.

To study the effect of informing patients with video before cardiac surgery on intensive care experience. This randomized controlled trial was conducted between December 2021 and December 2022 in the cardiovascular surgery clinic of a public hospital with the participation of 90 patients (45 patients in experimental group - 45 patients in control group) who were scheduled to undergo cardiac surgery. Patient Information Form and Intensive Care Experiences Scale were used for study data. Patients in experimental group were informed with video about the intensive care before cardiac surgery. It was found that the total score on ICES of the experimental group (74.5±3.9) was statistically and significantly higher than that of the control group (63.9±6.4) (p<0.001). The sub-dimension of awareness of surroundings (20.8±1.7), the frightening experiences (18.6±1.0), and the recall of experience (18.5±1.5) and satisfaction with care (16.7±1.4) were found to be statistically significantly higher in the experimental group, than in the control group sub-dimension scores (p<0.001). It was found that informing patients with video about the intensive care setting and process before cardiac surgery had a positive effect on the intensive care experience. Note: The study was produced from a master's thesis and was not presented. All participants gave informed consent for the study, and that their anonymity was preserved.Trial Registration NO.: NCT05255887.

Early and midterm outcomes of EVAR with 34 and 36 mm large endograft sizes: A single tertiary center study

Aim: Endovascular aneurysm repair (EVAR) has become a preferred method for accessing anatomically suitable abdominal aortic aneurysms in recent years. Advances in techniques and materials have led to the management of more challenging cases. Anatomical difficulties in the structure of the aneurysm neck can adversely affect the success of the procedure. In this study, we aimed to evaluate early and midterm outcomes in patients with wide-necked infrarenal abdominal aortic aneurysms treated with 34 mm or 36 mm EVAR endografts. Material and Methods: We evaluated infrarenal abdominal aortic aneurysms treated with 34 mm or 36 mm long EVAR allografts between January 2019 and January 2023 at Ankara Bilkent City Hospital Cardiovascular Surgery Clinic. We included and assessed patients with a neck diameter of 28 mm or greater using follow-up computed tomography angiography (CTA). We evaluated early and midterm morbidity and mortality as well as endovascular complications such as endoleak or migration. Results: A total of 58 patients with wide-neck infrarenal abdominal aortic aneurysms underwent 34 mm or 36 mm EVAR endograft deployment. There was no early mortality. The mean follow-up period was 21.7±6.4 months. Eight patients were found to have endoleaks—four had type 2 endoleaks, two had type 1b endoleaks, one had type 3 endoleak and one had type 1a endoleak. Except for type 2 endoleaks, all patients underwent endovascular reintervention. Conclusion: Our study demonstrated the successful application of 34 mm or 36 mm long endografts to patients with abdominal aortic aneurysms with a wide neck diameter. Regarding the midterm outcomes, standard EVAR procedures with large endografts are feasible and have successful outcomes.

Salvage of brachiocephalic aneurysmatic fistulas, using ePTFE graft with a minimally invasive approach.

In this study, we evaluated our surgical approach in requiring surgical treatment of brachiocephalic arteriovenous fistula (AVF) aneurysms for salvage of AVF. Between 2012 and 2022, 20 patients (16 men, 4 women; mean age 54.5 years) who were surgically treated for a brachiocephalic AVF aneurysm in our Cardiovascular Surgery Clinic were evaluated retrospectively. These 20 patients were operated on for aneurysm thrombosis and fistula failure in 16 patients, sudden rupture and severe bleeding in 3 patients, cosmetic reasons, and anxiety in 1 patient. These aneurysms were ligated and divided from distal and proximal cephalic veins. Then, a 6 mm dialysis graft was interposed between the well-developed cephalic vein distal and proximal to the aneurysm with small skin incisions. All patients were taken to dialysis via this dialysis graft 24 h after the procedure without any problem. All patients were discharged after dialysis. After surgery, no catheterization or any other additional procedure was required for hemodialysis. No complications, such as infection, hematoma, neurological damage, or ischemia, were observed after the surgical procedure. The mean postoperative follow-up was 12 months. In brachiocephalic AVF aneurysms requiring surgical treatment, hemodialysis can be continued with a graft placed in the same arm in this technique.

Should varicocele screening be conducted in men diagnosed with chronic venous insufficiency? A prospective study.

It has been previously proposed in numerous studies that chronic venous insufficiency (CVI) has similar pathogenesis to varicocele in males. Varicocele has been identified as the most common cause of infertility in men, accounting for 40% of cases. This study investigates whether varicocele screening should be conducted in patients with CVI and, if so, which patients should undergo such screening. The study included 102 adult male patients with venous insufficiency complaints who presented to the cardiovascular surgery clinic between January 2023 and June 2023. Data were prospectively collected through medical history interviews and Doppler ultrasound measurements performed by a single radiologist. The relationship between non-normally distributed measurement data of the two groups was evaluated using the Mann-Whitney U test, while the association between categorical variables was assessed using the χ2 test. ROC analysis was employed for determining predictive value. A type 1 error level of α = 0.05 was adopted. The mean left great saphenous vein (GSV) diameter of those with varicocele (6.6 ±2.3) was significantly larger compared to the mean left GSV diameter of those without varicocele (5.3 ±2.6) (p = 0.004). The area under the ROC curve for left GSV diameter was 67% (p = 0.005). When varicocele screening is performed in patients with a left GSV diameter of 5.35 cm and above, sensitivity is 71.4% and specificity is 61.2%. There is a significant association between left GSV diameter and varicocele (p = 0.004). Varicocele screening can be carried out with 71.4% sensitivity in adult male patients with a left GSV diameter of 5.35 cm and above. Both cardiovascular surgeons and radiologists can conduct varicocele screening by measuring pampiniform veins in patients with a left GSV diameter of 5.35 cm and above. This approach has the potential to reduce the incidence of varicocele and associated infertility.

Evaluation of Current Professional Practices of Perfusionists: Survey Study

Introduction: Cardiac surgical procedures performed with extracorporeal circulation or perfusion techniques retain their importance in treating heart disease and often represent an alternative method.&#x0D; Objective: This survey aimed to identify and evaluate the current practice of perfusionists in cardiovascular surgery clinics in Turkey.&#x0D; Materials and Methods: This study is a prospective and descriptive etiological study. Surveys regarding the current practices of perfusionists were created as part of the study. The created surveys were sent to perfusionists in Turkey voluntarily through the application "Google Forms", and the data were collected. The data obtained from the surveys were statistically analyzed.&#x0D; Results: In this study, 80 perfusionists from 28 centres participated in the survey. Thirty-four participants were under 30 years old, 12 were between 31 and 35 years old, 16 were between 36 and 40 years old, and 16 were over 40 years old. Of the participants, 46 were female and 34 were male. The study collected descriptive data, information on cardiac clinics, CPB practices, use of cardioplegia, and other assistive devices.&#x0D; Conclusion: There have been significant advances and changes in cardiac surgery surgeries performed with CPB over approximately 70 years from the past to the present. However, we believe that there are ongoing or pending issues.

Early effects of cardiopulmonary bypass surgery on retinal nerve fiber layer and ganglion cell layer

PurposeTo determine the effects of cardiopulmonary bypass surgery on retinal nerve fiber layer, ganglion cell layer, and macula by optic coherens tomography (OCT). MethodSixty-six eyes of 33 patients aged between 44 and 74 who were indicated for cardiopulmonary bypass surgery in the cardiovascular surgery clinic were included in the study. Routine ophthalmologic examinations of all patients were performed before and 1 week after surgery. In addition, 3D(H) Macula+5 Line Cross 12 × 9 mm mod and Peripapilar 3D Disk 6 × 6 mm mod data were analyzed with OCT (Topcon, Triton Swept Source-OKT, Tokyo, Japan) device. Peripapillary total, superior, inferior retinal nerve fiber layer (RNFL), optic disc cavity volume, cup-to-disc ratio, macular ganglion cell layer (GCL), macular thickness were compared before and after surgery. ResultsAfter cardiopulmonary bypass surgery, thickening was detected in the total RNFL (p<0.001), superior RNFL (p = 0.01) and inferior RNFL (p<0.001) layers. There was no change in the values of GCL, macular thickness, optic disc cupping volume, cup-to-disc ratio after surgery (p>0.05).There was a positive correlation (r = 0.392 p<0.05) between the patients' blood oxygen (PO2) values during bypass surgery with their post-surgical GCL+ values, and a negative correlation between optic disc cup volumes (r=-0.349 p<0.05). ConclusionRNFL thickening has been detected in patients undergoing cardiopulmonary bypass surgery. This thickening may occur secondary to ischemic edema that occurs during surgery. Considering the late complications of ischemic edema in the RNFL, oxygen levels should be kept at an optimum level during surgery and long-term ophthalmologic follow-ups should be performed.

Pulmonary atresia and ventricular septal defect: How accurate is the fetal echocardiography, and do the major aortopulmonary collateral arteries matter?

To assess the accuracy of prenatal echocardiography in defining pulmonary vasculature in pulmonary atresia with VSD (PAVSD). The second aim is to compare the perinatal and postnatal outcomes of different pulmonary blood supply types. The cases prenatally diagnosed with PAVSD between 2017 and 2022 in a single tertiary fetal medicine center were identified on the electronic database. Fetal echocardiography reports and images were reviewed retrospectively. Postnatal outcomes were acquired from the hospital records of relevant pediatric cardiology and cardiovascular surgery clinics. Fetal echocardiography results were compared with postnatal results. Perinatal and postnatal outcomes were compared between the different pulmonary vascular supply types. Among the 24 PAVSD cases, six were diagnosed with major aortopulmonary collateral arteries (MAPCA) dependent, eleven were diagnosed with ductus arteriosus (DA) dependent pulmonary supply, and seven were diagnosed with double pulmonary supply (MAPCA + DA) on prenatal echocardiography. Seventeen cases were live-born and have undergone postnatal investigations. Fetal echocardiography was 88.2% accurate about the type of pulmonary supply. The accuracy of fetal echocardiography regarding pulmonary vascular anatomy was 82.3%. Postoperative survival was 69.2%. Mortality before surgery and postoperative survival did not differ between pulmonary supply groups. Survival was impaired by the extracardiac anomalies. The need for early interventions was significantly higher in the DA group. Pulmonary vascularization in PAVSD can be defined precisely on fetal echocardiography. The source of pulmonary blood supply does not impact postnatal short-term outcomes significantly but it impacts the management. The associated anomalies highly contribute to postnatal mortality.

Evaluation of the readability of consent forms used in cardiovascular surgery clinics

Aims: The readability of the informed consent forms, which are a power of attorney agreement between the physician and the patient, is very important especially in clinics where high-risk procedures such as cardiovascular surgery are performed. In this study, we aimed to determine the readability levels of consent forms, which are frequently used in cardiovascular surgery clinics, according to accepted scales.&#x0D; Methods: The readability level of the 15 patient consent forms recommended by the Turkish Society of Cardiovascular Surgery to its members; word counts, syllable counts, letter and character counts were calculated using Ateşman and Bezirci-Yılmaz formulas.&#x0D; Results: Consent forms included in the study were found to be readable at the 11-12th grade level according to the Ateşman scale and at the high school level in the Bezirci-Yılmaz scale. These texts have also been studied at international scales and it has been determined that they are at the level of readability that requires undergraduate education.&#x0D; Conclusion: Research and data from the Turkish Statistical Institute show that the average year of schooling in our country is 6.5, and the ratio of high school graduates or equivalent to the entire population is 22.3%. We advocate simplifying the informed consent forms recommended by the Turkish Society of Cardiovascular Surgery, from the level that requires high school education to the 6-year education level, which is the average schooling year in Turkey.

Tracheostomy experiences in chronic respiratory failure after congenital heart surgery

Introduction&#x0D; A small number of children with repaired congenital heart defects may require a tracheostomy for ongoing ventilatory support. Congenital airway anomalies, laryngomalacia, postoperative airway complications and genetic syndromes associated with airway and facial anomalies, such as DiGeorge Syndrome (22q11 deletion), can be counted among the reasons why patients are unable to be weaned from the ventilator. In this study, we aimed to define the outcomes of patients who required a tracheostomy due to chronic respiratory failure after congenital heart surgery, and the existing risk factors for in-hospital and post-discharge mortality.&#x0D; Materials and methods&#x0D; The files of 1382 patients who underwent surgery due to CHD in the Pediatric Cardiovascular Surgery Clinic in ……………., between February 2019 and February 2023, were retrospectively scanned. Patients’ age, gender, body weight, cardiac diagnosis, surgical intervention, length of stay in the intensive care unit, number of extubation attempts, total length of stay on the ventilator, need for ventilator at discharge, rates of weaning from tracheostomy and time of weaning from tracheostomy and mortality rates, were obtained from patient files and hospital database.&#x0D; Results&#x0D; Tracheostomy was performed in 15 of 1382 patients who underwent surgery during the four year study period. Mean (SD) duration of ventilation prior to tracheostomy was 35 days (IQR= 19 – 47). The median follow up time in patients was 224 days (IQR=116-538). Three patients were decannulated and six had died. Causes of death in six patients included sepsis (2), cardiac instability (1), neurological complications (2) and pulmonary haemorraghia (1). &#x0D; The median time to discharge after tracheostomy in patients was 51 days (IQR= 33.50 – 147). &#x0D; Eight patients (53.3%) were discharged on home ventilation. Causes of deaths were often multifactorial for children who died during their initial hospital stay. Mortality was seen in six patients, a rate of 40%. &#x0D; Conclusion&#x0D; The need for tracheostomy after cardiac surgery plays an important role in early and late mortality in children. Ventilator-dependent chronic respiratory failure is the most common cause of childhood tracheostomies. We believe that determining the optimal timing for tracheostomy in the pediatric population will be effective in reducing prolonged ventilation and tracheostomy-related morbidities.

Comparison of endovenous laser ablation and cyanoacrylate embolization in the non-invasive treatment of superficial venous insufficiency in terms of patient satisfaction.

Ablation with n-butyl cyanoacrylate is a clinically newer technique than endovenous laser ablation and other interventional techniques in the treatment of chronic venous insufficiency (CVI). The aim of this study was to compare the endovenous laser ablation (EVLA) and n-butyl cyanoacrylate (NBCA) interventional techniques in terms of benefit, effectiveness, and patient satisfaction. The study was conducted at Yozgat City Hospital and Bozok University Research Hospital Cardiovascular Surgery clinics between November 2016 and February 2021. A total of 260 symptomatic patients with 130 randomized cases in each intervention group were included. NBCA patients constituted Group 1 and EVLA patients Group 2. The saphenous vein was evaluated by color Doppler ultrasonography (CDUS) of the lower extremity. Patients with saphenous veins over 5.5mm in diameter and a saphenous-femoral reflux time of 2s or longer were included in the study. The patients were asked about their satisfaction and symptoms in the first postoperative week during an outpatient clinic follow-up with CDUS investigation at the first and sixth months. Although vena saphenous magna (VSM) closure results were similar with the two methods, satisfaction rates were found to be higher with the NBCA procedure. Comparison of the new methods used in the treatment of CVI revealed similar VSM closure rates in the two methods, but the satisfaction rate was higher with the NBCA technique in this study.

New Biomarkers (Endocan, Interleukin-17, and Thrombospondin-4) for the Diagnosis, Assessment of Severity, and Follow-Up of Peripheral Arterial Disease.

The present study evaluated the use of endocan, interleukin-17 (IL-17), and thrombospondin-4 (TSP-4) blood levels as potential biomarkers for the diagnosis and follow-up of peripheral arterial disease (PAD). Patients with PAD (Rutherford categories I, II, and III) who were admitted between March 2020 and March 2022 for cardiovascular surgery or outpatient clinic follow-up were included. The patients (n = 60) were divided into 2 groups: medical treatment (n = 30) and surgical treatment (n = 30). In addition, a control group (n = 30) was created for comparison. Endocan, IL-17, and TSP-4 blood levels were measured at the time of diagnosis and at the first month after treatment. Endocan and IL-17 values were found to be significantly higher in both groups that underwent medical (259.7 ± 46pg/mL, 63.7 ± 16.6pg/mL) and surgical (290.3 ± 84.5pg/mL, 66.4 ± 19.6pg/mL) treatment than the control group (187.4 ± 34.5pg/mL, 56.5 ± 7.2pg/mL P < .001). Tsp-4 value was found to be significantly higher only in the surgical treatment group (15 ± 4.3ng/mL) than the control group (12.9 ± 1.4ng/mL P < .05). The decreases in endocan, IL-17, and TSP-4 levels at the first month of treatment in both groups were also significant (P < .001). A combination of classical and these new biomarkers could be included in PAD screening, early diagnosis, severity determination, and follow-up protocols in order to provide effective assessment in clinical practice.

Long-term results of coronary bypass grafting supplemented with surgical stimulation of extracardiac myocardial vascularization in patients with diffuse coronary artery disease

Highlights. In recent decades, the number of patients with diffuse, multivessel coronary artery disease has increased due to widespread use of endovascular methods of treatment, long-term conservative management of patients, and the expansion of indications for surgical revascularization. In order to improve the results of treatment, in 2007 academician Yu. L. Shevchenko developed and began using the method of stimulation of extracardiac angiogenesis – «YurLeon». The present article demonstrates the long-term results of supplementing coronary bypass surgery with this method in patients with diffuse coronary artery disease.Aim. To evaluate long-term results of coronary bypass surgery supplemented by extracardiac myocardial revascularization.Methods. The prospective, randomized study included 205 patients with diffuse, multivessel coronary artery disease who were treated at the St. George Thoracic and Cardiovascular Surgery Clinic, National Medical and Surgical Center named after N.I. Pirogov. The majority of patients were men – 75% (n = 153), whereas women accounted for 25% (n = 52), all patients were 60 to 78 years old (67.3±5.74 years). The group I consisted of patients with coronary bypass surgery supplemented with the «YurLeon» technique, the group II consisted of patients with coronary bypass grafting only. All patients provided consent to participate in the study. The clinical condition of patients, echocardiography, myocardial scintigraphy and coronary angiography data, quality of life indicators (the 36-Item Short Form Health Survey) were assessed.Results. In the long-term postoperative period (36 months), the group I, compared with the group II, presented with a statistically significant decrease in the functional class of angina pectoris (1[1–2] vs. 2[1–2], p = 0.02); fewer adverse events: myocardial infarction (4.5% vs. 11.6%, p = 0.011), recurrent angina pectoris (10% vs. 17.9%, p = 0.038); an increase in the left ventricular ejection fraction (59.0±5.15% vs. 53.2±6.13%, p = 0.001); a decrease in the Summed Rest Score (SRS) (4.5±3.5 vs. 8.4±5.7, p = 0.012) according to myocardial scintigraphy with technetril; a decrease in the Summed Thickening Score (STS) (6.1±3.3 vs. 10.7±2.9, p = 0.012); a decrease in the hibernating myocardium (3.5±2.2% vs. 7.4±5.1%, p = 0.03); additional extracardiac sources were found in the group I according to coronary graft angiography, there were no statistically significant differences between the groups by occluded autogenous venous bypass grafts (in the group I – 23 out of 46 venous conduits (49%), in the group II – 30 out of 49 venous conduits (51%), p = 0.089); The groups differed in terms of quality of life (the 36-Item Short Form Health Survey): physical functioning (87.3±10.32 vs. 75.3±14.15 points, p = 0.001); role-based functioning due to physical condition (90.1±10.50 vs. 79.7±7.01 points, p = 0.012); pain (93.10±6.37 vs. 80.5±5.21 points, p = 0.03); the total physical component of health (57.9±5.4 vs. 45.8±6.1 points, p = 0.012).Conclusion. We have accumulated 15 years of experience in conducting complex myocardial revascularization in patients with coronary artery disease and diffuse coronary atherosclerosis, which allowed us to prove the effectiveness and safety of the YurLeon technique.

Determination of Knowledge and Attitudes of Cardiac Surgery Nurses Regarding the Enhanced Recovery After Surgery Protocol

PurposeThis study aimed to examine the knowledge and attitudes of cardiac surgery nurses regarding the enhanced recovery after surgery protocol. DesignThis was a descriptive, cross-sectional study. MethodsThe sample consisted of 50 nurses working in the cardiovascular surgery clinic of a university hospital in the province of Izmir, Turkey. A questionnaire consisting of three sections was prepared by the researchers to collect data. The first section of the form captured sociodemographic and descriptive characteristics; the second section examined the level of knowledge about the enhanced recovery protocol for cardiac surgery; the third section captured the nurses' attitudes regarding the enhanced recovery protocol. The questionnaire was distributed to the nurses and the research data were collected after a certain amount of time. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, and correlation analysis were used in the analysis of the data. FindingsThe mean age of the nurses was 31.26 ± 6.74 (min = 23, max = 47); 78% were female; 76% had a bachelor's degree; 48% were employed in the intensive care unit. The mean score of the nurses regarding their level of knowledge on the enhanced recovery protocol for cardiac surgery was 18.70 ± 5.29 (min = 0.00, max = 28.00); the mean score regarding attitude toward the enhanced recovery protocol after surgery was 30.00 ± 3.86 (min = 12.00, max = 33.00). There was a positive, moderate, statistically significant correlation (r = 0.396, P = .005) between the mean knowledge level score and the mean attitude level score. ConclusionsResults showed that nurses' knowledge was at a moderately positive level. Increasing the level of knowledge increased positive attitudes. Recommendations include disseminating protocol information and providing necessary training to increase positive attitudes in an effort to ensure protocol adherance.

Evaluation of Kinesiophobia and Fatigue Levels of Patients Who Have Undergone Open Heart Surgery

Purpose: This study aimed to determine the kinesiophobia and fatigue levels of patients who underwent open heart surgery.&#x0D; Methods: The study was conducted with 176 patients who underwent traditional open heart surgery in the cardiovascular surgery clinic of a hospital located in Trabzon, Turkey. The data were gathered using a personal information form, the Tampa Kinesiophobia Scale, and the Piper Fatigue Scale.&#x0D; Result: It was determined that patients had high levels of kinesiophobia and moderate levels of fatigue. A statistically meaningful difference was found between mean total Tampa Kinesiophobia Scale scores and age and employment status and between the mean total Piper Fatigue Scale scores and subscale scores of patients according to gender, body mass index, and employment status. There was a statistically significant positive and moderate correlation between patients’ Tampa Kinesiophobia Scale scores and the behavioral, affectivity, and sensory subscales and total score of the Piper Fatigue Scale while there was significant, positive, and weak correlation with the cognitive subscale of the Piper Fatigue Scale.&#x0D; Conclusion: Considering the kinesiophobia and fatigue levels of patients undergoing open heart surgery in the nursing care process before and after surgery may be useful for the performance of physical activities that will contribute to recovery.

Being on the Thorn: Senior Nurse and New Nurse Experiences in the Cardiovascular Surgery Clinic

Being on the Thorn: Senior Nurse and New Nurse Experiences in the Cardiovascular Surgery Clinic

Patient awareness, disease-specific knowledge, and patient adherence to endovascular treated elective infrarenal abdominal aortic aneurysm

Aim: Patient awareness and disease-specific knowledge are essential for shared decision-making of patients with abdominal aortic aneurysms. With this pilot survey, we aimed to figure out the obstacles to patient's awareness about the aortic aneurysm before and after the procedure. Material and Methods: Patients who experienced elective endovascular aortic aneurysm repair (EVAR) in our Cardiovascular Surgery Clinic between 2019 to 2023 were the selected patient cohort. The first 50 patients who visited our outpatient clinic were given a questionnaire about their awareness of the aneurysm disease, disease-specific knowledge, and the comprehensibility of the patient information provided before and after the procedure. Results: The mean age of our patients was 66±6.9. Younger patients were more aware of the situation before the information (p=0.013). Patients anxious about the disease were also more conscious about the aortic aneurysm (p=0.02). Although all patients were given preoperative information and disease-specific information by the same team, 13 patients (26%) could not recall anything about the disease and did not recall what operation was performed and why. Thirty-seven patients (74%) gained awareness about the disease. The patients with at least an educational level above high school gained more awareness than others (p=0.04). Conclusion: The Classical informatory model seems insufficient for gaining awareness and consciousness for older patients and with patients with low level of education. Strengthened patient-practitioner interaction with supplemental technologies (leaflets, interactive media, audio tapes, etc.) may improve these patients' shared decision-making. More prospective research is required in this regard.

Evaluation of mid-term results in our patients treated with N-Butyl cyanoacrylate embolization in saphenous vein insufficiency

Aim: The aim of this study is to present our mid-term results obtained from patients with advanced saphenous vein insufficiency treated with N-butyl cyanoacrylate embolization (CAE). Material and Methods: In the present study, we included 1013 patients who were treated with CAE because of moderate and severe saphenous vein insufficiency in Eskişehir Osmangazi University Medical Faculty Hospital Cardiovascular Surgery Clinic between January 2015 and November 2019. The patients were rechecked at 1st, 6th, 12th, 24th and 36th months. Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) results recorded at preoperative and postoperativee period. Doppler ultrasonography (USG) was performed to all patients in all controls. The absence of re-canalized flow in Doppler USG was accepted as the success of the procedure. Results: The mean age of 1013 patients was 51.27±14.30 years (448 men (44.2%) and 565 women (55.8%)). The average procedure time was 12.4±2.1 minutes, the average amount of CA used in the procedure was 1.6 ml (min: 1 ml - max: 2ml). In outpatient controls, complication rates was low, thrombophlebitis occurred in 17 patients (1.7%) and ecchymosis occurred in 9 patients (0.9%). The occlusion rate was 97.6% according to the 1-year follow-up results and 93.3% according to the 3-year follow-up results. The decrease in VCSS and AVVQ scores was statistically significant when the preoperative and postoperative period results compared (p&lt;.05). Conclusion: In the present study, we think that CAE is a safely and effective treatment method for saphenous vein insufficiency. It has low complication, high occlusion rates and provides better comfort to the patients.