INTRODUCTION: Frailty syndrome is a significant risk factor for elderly patients undergoing cardiovascular surgery. However, there is no consensus on which criteria are most effective for assessing frailty in this context.
OBJECTIVE: This study aimed to evaluate the relationship between different widely cited frailty syndrome criteria and postoperative morbidity and mortality.
METHODS: Patients aged ≥ 60 years scheduled for coronary artery bypass graft, valve, and/or ascending aortic surgery were assessed for frailty preoperatively. Frailty was defined by Clinical Frailty Scale (CFS) ≥ 4, Katz Index ≥ 1, Short Physical Performance Battery (SPPB) ≤ 6, Fried Frailty Phenotype (FFP) ≥ 3 or abnormal values in 15-feet gait speed (GS) test, or hand grip strength. Clinical outcomes, including mortality and major adverse cardiovascular and cerebral events (MACCE), were assessed 30 days post-surgery.
RESULTS: Among 137 patients (70.1% male, mean age 69.43 ± 5.98 years), frailty prevalence ranged from 13.1% to 43.1%, depending on criterion, with no significant differences by age strata or surgery type. At 30-day follow-up, mortality was 5.1% (n = 7), and a total of 29 MACCE (21.1%) were recorded. Patients identified as frail by the FFP, CFS, SPPB, and GS criteria showed a significant association with mortality and MACCE. Multivariate analysis indicated FFP and CFS as independent risk factors for MACCE with equivalent prognostic prediction.
CONCLUSION: Frailty is a prevalent condition among elderly patients undergoing cardiovascular surgery and is associated with mortality and morbidity. Frailty defined by FFP and CFS criteria was independently associated with higher MACCE rates.

INTRODUCTION: Reoperative cardiac surgery is associated with a higher risk of complications due to technical difficulties compared to the first-time surgery. This study aims to compare the early outcomes of median sternotomy (MS) and lateral thoracotomy (LT) procedures in patients with a history of previous open-heart surgery who underwent left ventricular assist device (LVAD) implantation with cardiopulmonary bypass (CPB).
METHODS: A retrospective analysis was conducted on 36 patients who received LVAD implants for end-stage heart failure between November 2012 and June 2015. The patients were divided into Group 1 (MS, n = 18) and Group 2 (LT, n = 18).
RESULTS: The mean age of the patients was 57.2 ± 9.4 years (range: 24 – 70 years), and only 8.3% were female. Demographic data, preoperative characteristics, use of blood products, anesthetic drugs, and complications were similar in both groups (P > 0.05). The MS group had significantly longer operation duration (101 ± 46 minutes vs. 70 ± 20 minutes, P = 0.038) and CPB time (328 ± 79 minutes vs. 265 ± 47 minutes, P = 0.048) compared to the LT group. Postoperative analgesic consumption and pain scores were similar between the two groups (P > 0.05).
CONCLUSION: In patients with a history of previous cardiac surgery, LVAD implantation with LT through CPB demonstrated favorable outcomes regarding reduced operation duration and CPB time. However, it did not positively impact the duration of stay in the intensive care unit, hospital stay, use of blood products, and complications.

INTRODUCTION: Choosing a surgical technique in patients with acute type A aortic dissection is still a debatable issue. In patients with massive aortic root destruction, the Bentall procedure is a gold standard. Aortic valve reimplantation is a reliable alternative, especially in patients with the preserved anatomy of aortic valve leaflets.
OBJECTIVE: To compare the results of modified valve sparing procedure and composite root replacement in patients with acute type A aortic dissection.
METHODS: In total, 62 patients were included in this study. Of those, 27 patients underwent aortic valve reimplantation, and 35 had the Bentall procedure with the Kouchoukos modification.
RESULTS: Preoperative demographics and clinical characteristics were analyzed in both groups. Similar indicators of preoperative malperfusion were observed in both. Cardiopulmonary bypass time (P = 0.125) and aortic clamping time (P = 0.001) were longer (≈ 30 minutes) in the reimplantation group while the time of circulatory arrest was longer in the Bentall group (P = 0.290). Hospital mortality rates were 8.3% in the reimplantation group and 22.9% in the Bentall group. During the long-term follow-up period, there were six (25%) deaths in the reimplantation group and 10 (28.6%) deaths in the Bentall group. The aortic regurgitation degree was stable in all cases up to the moment of last contact with the patients.
CONCLUSION: Modified aortic valve reimplantation shows good immediate and long-term outcomes in patients with acute type A aortic dissection.

OBJECTIVE: This study aimed to investigate the frequency of persistent left superior vena cava (PLSVC) and its impact on outcomes in children undergoing congenital heart surgery.
METHODS: The study was conducted retrospectively in cases diagnosed with congenital heart disease who were operated on under the age of 16 years between October 1st, 2021, and October 1st, 2024, at two major tertiary centers. The frequency of PLSVC and its possible impact on surgical outcomes were evaluated in these cases. The results were analyzed statistically.
RESULTS: There were 4,000 cases during the study period, with 52% being male. The median weight was 5.2 kg (interquartile range 4.5 - 6 kg). PLSVC was detected in a total of 260 cases (6.5%). Of these cases, 92.3% (240/260) drained into the coronary sinus, while 7.7% (20/260) drained directly into the left atrium. In 251 (96.5%) of the patients with PLSVC, there was a right SVC, while nine (3.5%) did not have a right SVC. Of the 251 patients with double SVC, 105 (42%) had a normal innominate vein. PLSVC was primarily associated with heterotaxy syndrome, atrioventricular septal defect, and vascular ring defects.
CONCLUSION: There is an increased frequency of PLSVC among certain congenital heart disease groups, and raising awareness during echocardiographic examination can facilitate the diagnosis of PLSVC. Preoperative diagnosis of PLSVC can help in managing complications more effectively

INTRODUCTION: The aims of this study are to compare sternal closure techniques (single, figure-of-8, and combined use) in patients undergoing cardiac surgery and to investigate their relationship with postoperative sternal complications.
METHOD: Between 2023 and 2024, 645 patients (470 males; mean age 58.5 ± 11.1 years) who underwent cardiac surgery were evaluated. The patients were divided into three groups: Group 1, simple wire (n = 141); Group 2, figure-of-8 (n = 224); and Group 3, combination of these two techniques (n = 280). Preoperative and perioperative data, postoperative complications, and sternal complications were compared between these groups.
RESULT: The distribution ratio of the groups is 141 (22%), 224 (35%), and 280 (43%) in Groups 1, 2, and 3, respectively. There was no significant difference between the groups regarding basic demographic characteristics, comorbidities, and operative data. There was no difference between the groups in terms of postoperative exploration, delayed chest closure, subxiphoid decompression, superficial sternal wound infection (SSWI), deep sternal wound infection (DSWI), vacuum-assisted closure usage, intubation time, intensive care unit stay, and mortality. The hospital stay was found to be shorter in Group 3 compared to the other groups (median 8 days - 7 days, P = 0.02).
CONCLUSION: In patients undergoing cardiac surgery, we found no difference in sternal complications (DSWI, SSWI) between the three most commonly used closure techniques (simple wire, figure-of-8, and their combination). We found that the length of hospital stay was shorter in patients with the combined technique than in the other two techniques.

INTRODUCTION: Orthotopic heart transplantation (OHT) has become the standard of care for children with end-stage heart failure refractory to medical or surgical therapy. Despite the improvement in perioperative survival in the last decades, the long-term complications and mortality remain significant. This report examines the experience of a single center in Brazil with pediatric OHT, focusing on long-term results and mortality.
METHODS: This is a retrospective study from January 2002 to December 2022. Data collection consisted of demographic data, indication for heart transplantation, immunosuppression, main complications, and mortality.
RESULTS: There were 77 OHT in 74 patients. The median age at the time of OHT was 11.5 years (interquartile range 0.25 – 22 years). The indications for OHT were congenital heart disease in 46.8%, cardiomyopathy in 45.5%, and retransplantation in 3.9% of the patients. There was an average of 2.2 rejection episodes/patient and 1.3 infection episodes/patient during the first year of follow-up. The most common long-term complications were acute kidney injury (51%), systemic arterial hypertension (40.5%), and post-transplantation diabetes mellitus (10.4%). Overall survival after one year of OHT was 89.6% and five- and 10-year survivals were 80% and 59%, respectively.
CONCLUSION: Heart transplant is an acceptable therapeutic option for children and young adults in middle-upper income countries, with outcomes and long-term follow-up close to those of high-resource countries.

INTRODUCTION: Perfusion accidents still threaten the safety of perfusion during open-heart surgery. To prevent these accidents and increase perfusion safety, it is important to first determine the profile of perfusionists. The aims of this study were to determine the current status of perfusion safety during open-heart surgeries in Turkiye and to investigate the knowledge, attitudes, and experiences of perfusionists about cardiopulmonary perfusion safety.
METHODS: First, 148 perfusionists answered the Perfusionists' Attitudes on Perfusion Safety survey, and second, 109 perfusionists answered the Perfusion Safety and Accidents survey. In the first survey, perfusionists' attitudes and opinions help us understand the profile of Turkish perfusionists. In the second survey, we tried to obtain experiences and data about perfusion accidents, experienced by the participant perfusionists, to make a detailed analysis.
RESULTS: Turkish perfusionists are willing to ensure perfusion safety and prevent accidents. In this study, however, we found that educational institutions and clinics have not transmitted enough knowledge to perfusionists related to perfusion safety issues. There is some lack in the perfusionists knowledge about perfusion safety and preventing or reducing perfusion accidents.
CONCLUSION: Perfusionists need more training to ensure perfusion safety and to prevent perfusion accidents. It would be very beneficial to include a course on perfusion safety in academic settings that focuses on this subject in the curricula. Further comprehensive studies on this subject will make very important contributions to the practical perfusion applications in increasing perfusion safety and reducing perfusion accidents.

INTRODUCTION: The advantages of beating heart tricuspid surgery without aortic cross-clamping remain underexplored, particularly in the context of concomitant procedures. This study aimed to compare the short- and long-term outcomes of tricuspid valve surgery performed with and without aortic cross-clamping.
METHODS: This retrospective cohort study included 1,154 patients who underwent isolated or concomitant tricuspid valve surgery between 2009 and 2021. Patients were divided into two groups, those who underwent surgery without aortic cross-clamping (beating heart, n = 170) and those with cross-clamping (arrested heart, n = 984). Propensity score matching identified 139 matched pairs.
RESULTS: The mean age was 56 years (25^th-75^th percentiles: 47, 65), with 61.27% female patients and 95% undergoing concomitant procedures. In the unmatched cohort, patients who underwent beating heart surgery had higher preoperative creatinine clearance (93.53 vs. 81.33 ml/min, P = 0.036) and shorter intensive care unit stays (3 [1 – 5] vs. 3 [1 - 6] days, P = 0.037). However, after propensity score matching, there were no significant differences in postoperative heart block (P > 0.99), creatinine levels (P = 0.780), or tricuspid regurgitation grade (P = 0.082) between the two groups. Long-term outcomes, including 10-year freedom from reintervention (95% vs. 98%, log-rank P = 0.087), survival (77% vs. 82%, P = 0.964), and heart failure rehospitalization (76% vs. 77%, P = 0.444), were also comparable between the matched cohorts.
CONCLUSION: Concomitant tricuspid surgery without aortic cross-clamping is a viable alternative to traditional arrested heart surgery, with no significant differences in short- or long-term outcomes.

Introduction: Postoperative atrial fibrillation (POAF), the pathophysiology that includes inflammation and oxidative stress, is associated with increased hospital length of stay, mortality, and complications. The uric acid-to-albumin ratio reflects the inflammatory status of the body. We sought to evaluate whether there is an association between POAF and uric acid-to-albumin ratio in patients undergoing cardiac surgery.
Methods: Five hundred forty-three patients who developed POAF and 166 patients who did not formed our control and study groups, respectively. Patients who had an episode of atrial fibrillation lasting > 30 seconds were considered to have POAF. The uric acid-to-albumin ratio was calculated for each patient.
Results: Patients who developed POAF were older; had higher rates of hypertension, carotid artery disease, left atrial diameter, urea, creatinine, uric acid, and C-reactive protein levels; and had lower hemoglobin and albumin levels. The uric acid-to-albumin ratio of patients with and without POAF was 1.65 ± 0.63 and 1.26 ± 0.39, respectively (P < 0.001). Compared with uric acid and albumin, uric acid-to-albumin ratio had the highest area under the curve for predicting POAF (0.681, 0.449, and 0.702, respectively). Age and hemoglobin concentration were predictors of POAF. Although uric acid and albumin did not reach statistical significance for predicting POAF, the uric acid-to-albumin ratio had predictive value for the development of POAF.
Conclusion: The ability of the uric acid-to-albumin ratio to predict POAF in cardiac surgery patients and its nonnegligible benefits justify its use in clinical practice.