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Item Leukocyte-Endothelium Interaction in the Sublingual Microcirculation of Coronary Artery Bypass Grafting Patients(KARGER, 2020-01-01) Uz, Zuhre; Aykut, Guclu; Massey, Michael; Ince, Yasin; Ergin, Bulent; Shen, Lucinda; Toraman, Fevzi; van Gulik, Thomas M.; Ince, CanObjective: The aim of this study was to apply an innovative methodology to incident dark-field (IDF) imaging in coronary artery bypass grafting (CABG) patients for the identification and quantification of rolling leukocytes along the sublingual microcirculatory endothelium. Methods: This study was a post hoc analysis of a prospective study that evaluated the perioperative course of the sublingual microcirculation in CABG patients. Video images were captured using IDF imaging following the induction of anesthesia (T-0) and cardiopulmonary bypass (CPB) (T-1) in 10 patients. Rolling leukocytes were identified and quantified using frame averaging, which is a technique that was developed for correctly identifying leukocytes. Results: The number of rolling leukocytes increased significantly from T-0 (7.5 {[}6.4-9.1] leukocytes/capillary-postcapillary venule/4 s) to T-1 (14.8 {[}13.2-15.5] leukocytes/capillary-postcapillary venule/4 s) (p < 0.0001). A significant increase in systemic leukocyte count was also detected from 7.4 +/- 0.9 x 10(9)/L (preoperative) to 12.4 +/- 4.4 x 10(9)/L (postoperative) (p < 0.01). Conclusion: The ability to directly visualize leukocyte-endothelium interaction using IDF imaging facilitates the diagnosis of a systemic inflammatory response after CPB via the identification of rolling leukocytes. Integration of the frame averaging algorithm into the software of handheld vital microscopes may enable the use of microcirculatory leukocyte count as a real-time parameter at the bedside.Item Impact of coronary collateral circulation and severity of coronary artery disease in the development of postoperative atrial fibrillation(OXFORD UNIV PRESS, 2014-01-01) Sahin, Irfan; Ozkaynak, Berk; Karabulut, Ahmet; Avci, Ilhan Ilker; Okuyan, Ertugrul; Mert, Bulent; Avsar, Murat; Turna, Fahrettin; Kayalar, Nihan; Erentug, Vedat; Dinckal, Mustafa HakanOBJECTIVES: Atrial fibrillation (AF) after cardiac surgery has been reported to be approximately 30\%, making it one of the most important causes of morbidity and mortality post surgery. Although various clinical and laboratory predictors and underlying mechanisms progressing to postoperative AF have been proposed, the role of ischaemia in pathogenesis is doubtful. In this study, the association of coronary collateral circulation (CCC) and severity of coronary artery disease (CAD) with the development of postoperative AF was investigated. METHODS: A total of 597 patients who underwent on-pump coronary artery bypass surgery were included in the study. Pre-, peri-and postoperative variables were recorded in a computerized database. CCC and severity of CAD were documented for each patient according to Rentrop classification and Gensini score. RESULTS: Postoperative AF was observed in 96 patients (16.1\%). Advanced age, female gender, presence of hypertension and low haematocrit level were significantly associated with postoperative AF. By contrast, CCC and severity of CAD were not associated with postoperative AF (P = 0.22 and 0.5, respectively). Older age and lower preoperative haematocrit levels were the major predictors of postoperative AF development in the multivariate regression analysis. CONCLUSIONS: CCC and severity of CAD did not have a significant effect on the occurrence of postoperative AF, suggesting an ineffective role of myocardial ischaemia in the development of this condition.Item Can Partial Oxygen Pressure of Urine be an Indicator for Tissue Perfusion?(AVES, 2019-01-01) Tosun, Mclis; Ulugol, Halim; Aksu, Ugur; Toraman, FevziObjective: None of the advanced monitorisation procedures, which are focusing only on the haemodynamic and blood gas parameters, are sufficient to estimate tissue perfusion adequately. The search for new parameters that are non-invasive and reliable to provide information about tissue hypoperfusion is significant. The purpose of the present study was to evaluate the relationship between urine partial pressure of oxygen (PuO2) and routine systemic tissue perfusion parameters in patients with sepsis-like syndrome and impaired cardiac pressure-volume relationship after an open cardiac surgery. Methods: The study was designed in 50 patients who had elective coronary bypass surgery. Patients were assessed for arterial lactate levels, arterial partial oxygen pressure (PaO2), cardiac output (CO) and PuO2 in bladder urine at 180, 360 and 540 min postoperatively. Results: Tissue perfusion parameters were found to be similar throughout the surgery in addition to no significant rise in plasma creatinine levels. PuO2 was found to be 91 +/- 22, 99 +/- 22 and 97 +/- 13 mmHg, respectively, at the time points described above. Any correlation between PuO2 and other measurements was not determined at any time points. Conclusion: The present study suggests that urine PuO2 has no relationship with routine systemic tissue perfusion parameters, such as PaO2, lactate levels and CO. In our opinion, since the COs of the patients were within the normal limits, and none of the patients developed renal injury, the present study might have been unable to determine any correlation. Further studies focused on patients with transient renal ischaemia are needed.