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Öğe Comparison between normothermic and mild hypothermic cardiopulmonary bypass in myocardial revascularization of patients with left ventricular dysfunction(Sage Publications Ltd, 2013) Yuksel, V.; Canbaz, S.; Ege, T.Aims: The aim of this study was to investigate whether normothermic bypass is superior to mild hypothermia in patients with poor left ventricular function. This was achieved by studying defibrillation rates, postoperative requirements of cardiac pacing or other morbidity issues and mortality in patients with left ventricular dysfunction operated upon for elective coronary revascularization. Methods: Data were collected retrospectively from 252 consecutive patients with left ventricular dysfunction (ejection fraction <= 35%) undergoing coronary revascularization between January 2005 and January 2011. Patients operated upon under mild hypothermia (32 degrees C) were placed in Group 1 and under normothermia (>= 35 degrees C) were placed in Group 2. Comorbidities and postoperative complications were recorded. Results: There were 128 patients in Group 1 and 124 patients in Group 2. Plasma concentrations of CK-MB and troponin T peaked at 6 hours postoperatively, with no significant difference between the groups. Despite longer aortic cross-clamp time and total bypass time in Group 2, significantly less defibrillation requirement rates after aortic declamping was observed. Hospital mortality occured in 16 patients; 8 patients in each group. Conclusions: Normothermia enables less requirement for defibrillation after aortic declamping and postoperative cardiac pacing in patients with left ventricular dysfunction, which may be interpreted as better myocardial protection under normothermic bypass. However, maintaining normothermia had no effect on postoperative stroke, postoperative atrial fibrillation, renal failure development and mortality.Öğe Comparison of early and midterm Results of Kalangos Bioring® versus De Vega annuloplasty in functional tricuspid regurgitatione(John Wiley & Sons Ltd, 2010) Ketenciler, S.; Ege, T.; Sungun, M.; Canbaz, S.; Gurkan, S.; Huseyin, S.; Duran, E.[Abstract Not Available]Öğe Comparison of the efficacy of the cardiac hypothermia and normothermia to myocardial damage in coronary artery bypass graft surgery with systemic normothermic cardiopulmonary bypass(Edizioni Minerva Medica, 2013) Cakir, H.; Gur, O.; Ege, T.; Kunduracilar, H.; Ketenciler, S.; Duran, E.Aim. The aim of our research is to investigate the cardiac damage formed by either local cardiac hypothermia or cardiac normothermia technique in patients who undergone isolated coronary artery bypass graft (CABG) surgery. Methods. The total of 40 patients who underwent isolated CABG operation under normothermic cardiopulmonary bypass (CPB) were studied. Patients were randomly divided into two groups as cardiac hypothermia and cardiac normothermia. Myocardial temperature was measured from the interventricular septum before aortic cross-clamp (ACC) (baseline), the ACC 20th minutes (ischemia) and after 20 minutes removal of the ACC (reperfusion). The coronary sinus blood samples were simultaneously obtained from the retrograde cardioplegia cannula while myocardial temperature was being measured. Complement component 3 (C3), complement component 4 (C4), troponin I and tumor necrosis factor-alpha (TNF-alpha) was measured from the coronary sinus blood samples. Results. Myocardial temperature was between 18-28 degrees C (deep hypothermia) during ACC in group 1. Myocardial temperature was over 34 degrees C (normothermia) during ACC in group 2. TNF-alpha values of group 1 for ischemia and reperfusion were higher than group 2, and it was found statistically significant (P<0.05). Conclusion. Myocardial damage was less than in normothermia group according to hypothermia group. The results show that ice-cold blood cardioplegia and local ice treatment of the heart during CPB seems to harm the heart more than warm blood cardioplegia.Öğe Coronary artery bypass graft surgery in patients with left ventricular dysfunction(Edizioni Minerva Medica, 2015) Yuksel, V.; Canbaz, S.; Ege, T.Aim. The aim of this study was to investigate effects of congestive heart failure on coronary revascularization results in patients with left ventricular dysfunction and operated for elective coronary revascularization. Methods. The data were collected retrospectively from 126 consecutive patients with left ventricular dysfunction caused by coronary artery disease between January 2007 and January 2012. Patients admitted to hospital with angina complaints without congestive heart failure symptoms were group 1 and patients with severe congestive heart failure symptoms were group 2. Accompanying diseases, postoperative complications and mortality were recorded. Results. There were 66 patients in group 1 and 60 patients in group 2. Postoperative maximal inotropic support was necessary in 24 (36.4%) patients in group 1 for a mean duration of 1.6 +/- 0.9 days and in 34 (56.7%) patients in group 2 for a mean duration of 2.9 +/- 0.7 days. The proportion of patients with postoperative stay at the intensive care unit longer than 48 hours was significantly higher in group 2 compared to group 1. (p=0.0001) Hospital mortality was significantly higher in group 2 compared to group 1. (p=0.0001) Conclusion. Congestive heart failure aggravates the outcome after coronary artery bypass surgery in patients with left ventricular dysfunction.Öğe Early Results of surgical radiofrequency ablation in patients with atrial fibrillation undergoing open heart surgery(John Wiley & Sons Ltd, 2010) Gurkan, S.; Huseyin, S.; Ege, T.; Canbaz, S.; Canturk, M.; Dikmengil, M.; Duran, E.[Abstract Not Available]Öğe Evaluation of Iloprost to Prevent Vasospasm in Coronary Artery Bypass Grafts(Field House Publishing Llp, 2010) Ege, T.; Gur, O.; Karadag, C. H.; Duran, E.This study assessed the efficacy of iloprost in relieving vasospasm in coronary artery bypass grafts. Radial artery (RA), left internal thoracic artery (LITA) and saphenous vein (SV) grafts were taken from 20 patients (13 men and seven women, mean age 63.8 years [range 48 - 74 years]) scheduled to undergo coronary artery bypass grafting. Ten 3 mm vascular rings were cut from each graft and kept under tension for at least 60 min. They were kept alive with 37 degrees C oxygenated Krebs solution. Smooth muscle contraction was achieved with phenylephrine before iloprost was administered every 2 min, starting at a concentration of 10(-9) mol/l and increasing in logarithmic increments to a concentration of 10(-5) mol/l. The vasodilation response to iloprost started in all samples at a concentration of 10(-9) mol/l and increased with each incremental increase in iloprost concentration up to 10(-5) mol/l. These data suggest that local administration of iloprost has a role in relieving graft vasospasm during harvesting and preparation for coronary artery bypass grafting.Öğe In vitro effects of lidocaine hydrochloride on coronary artery bypass grafts(Edizioni Minerva Medica, 2012) Gur, O.; Ege, T.; Gurkan, S.; Gur, D. Ozkaramanli; Karadag, H.; Cakir, H.; Duran, E.Aim. Coronary artery bypass grafting (CABG) is one of the most common procedures performed to improve blood supply to myocardium. The characteristics of grafts, mechanical stress and pharmacological agents have substantial influence on the short and long term graft patency. Lidocaine is among the most frequently used antiarrhytlunic agents perioperatively. The aim of this study was to evaluate the in vitro effects of lidocaine on internal mammarian artery (IMA), radial artery (RA) and saphenous vein (SV) grafts. Methods. Using standard tissue bath techniques, responses to increasing concentrations of lidocaine hydrochloride were obtained, in segments of IMA, RA and SV grafts. Twenty patients were enrolled in the study with a total number of 48 grafts (16 for IMA, RA and SV grafts each). In vitro lidocaine concentrations between 10(-9)M and 10(-3.5)M were studied to represent therapeutic plasma concentration of 1.5-5 mcg/mL. Results. In IMA and RA grafts, lidocaine hydrochloride caused vasodilatation (40.5 +/- 1.9% and 39.1 +/- 2.6 % respectively) at concentrations between 10(-9) to 10(-7.5) M while causing a dose dependent vasoconstriction response at concentrations above 10(-7.5)M. In SV graft samples, lidocain hydrochloride caused vasodilatation (24.4 +/- 1.9 %) at concentrations between 10(-9) to 10(-7.5) M while causing dose dependent vasoconstriction at concentrations above 10(-7) M. For vasoconstriction effect, mean +/- SD values for E-max were calculated as: 120.1 +/- 6.6% in IMA, 83.35 +/- 5.06% in RA, and 154.0 +/- 13.8% in SV. The vasoconstriction in the SV samples was higher than in the RA and IMA. The mean SD LogEC(50) values were -5.15 +/- 0.27, -5.76 +/- 0.11 and -5.56 +/- 0.19 for SV, IMA and RA grafts respectively.) There was a statiscally significant differences in the Log EC50 values between SV, IMA and RA (P<0.005) Conclusion. Based on the results of our study, we conclude that, increasing doses of lidocaine in the perioperative period may cause vasospasm in IMA, RA and SV grafts. Thus, avoiding high doses may have a role in improving perioperative and long term mortality.Öğe Is it Necessary to Use an Intraluminal Shunt in Symptomatic Patients with Contralateral Carotid Artery Stenosis ?(Acta Medical Belgica, 2014) Yuksel, V.; Canbaz, S.; Ege, T.; Sunar, H.Background : We aimed to investigate our results of carotid endarterectomy operations in symptomatic patients operated by using an intraluminal shunt and without use of an intraluminal shunt in patients with contralateral carotid artery stenosis. Methods : We reviewed the results of 144 carotid endarterectomy operations in patients with contralateral carotid artery stenosis from January 2007 to December 2012. These patients were allocated in 2 groups. Group 1 (n = 70) consisted of the patients operated by using an intraluminal shunt and Group 2 (n = 74) consisted of the patients operated without use of an intraluminal shunt. Postoperative neurologic complications were recorded. Results : Temporary neurologic impairment developed in 3 (4.3%) patients postoperatively in group 1 and in 2 (2.7%) patients postoperatively in group 2. This difference was not statistically significant between groups (p = 0.675). None of the patients returned to operation theatre due to excessive bleeding postoperatively. The stroke/death rate was 0.7% in the study group. Conclusions : We conclude that carotid endarterectomy in symptomatic patients with contralateral occlusion can be performed safely without the systematic use of a shunt. However, it is not possible to define exact indications for use of a shunt as we have no information on the reason why some surgeons used a shunt.Öğe The reoperations that performed for bleeding after open heart surgery(John Wiley & Sons Ltd, 2010) Huseyin, S.; Gurkan, S.; Canbaz, S.; Ege, T.; Arslan, K.; Dikmengil, M.; Duran, E.[Abstract Not Available]Öğe The role of n-acetylcysteine in lower extremity ischemia/reperfusion(Edizioni Minerva Medica, 2006) Ege, T.; Eskiocak, S.; Edis, M.; Duran, E.Aim. To evaluate the efficacy of N-acetyl cysteine (NAC) in lower extremity ischemia/reperfusion. Methods. A total of 23 patients who underwent surgical intervention due to acute femoral artery occlusion were assigned into 2 groups: control group (group 1, n=12); and NAC group (group 2, n=11). Patients in NAC group received NAC before reperfusion, and 8 and 16 h after reperfusion (3x300 mg), while patients in control group received only NaCl 0.9% (3x100 ML). Catalase, malondialdehyde (MDA) and thiol concentrations were determined in femoral vein samples collected at 6 different time points: before reperfusion (t(1)), and 30 min (t(2)), 2 h (t(3)), 6 h (t(4)), 12 h (t(5)) and 24 h (t(6)) after reperfusion. Alveolar-arterial oxygen gradient (A-aO(2)) was calculated in radial artery blood samples simultaneously collected at the same time points. Results. No significant differences between the two groups with regard to age (control group 61 +/- 13 and NAC group 64 +/- 11 years), gender (control group M/F: 7/5, NAC 6/5) and the average time from onset of symptoms (control group 9.6 +/- 3.5 h, and NAC group 10.2 +/- 3.1 h) were present. Catalase enzyme activity increased with reperfusion in both groups and there were no differences between the two groups. MDA levels did not change significantly with reperfusion in NAC group, whereas they were significantly higher in control group at t2 and t3 compared to NAC group (P<0.05). Thiol concentrations decreased with reperfusion in control group, and in NAC group increases that started with reperfusion returned back to baseline levels after 24 hours. Although the A-aO(2) gradient increased in both groups with the beginning of reperfusion, the most prominent increase occurred in control group (P<0.05). Conclusion. In control group, the significant increase in MDA levels and A-aO(2) gradient in reperfusion phase were considered a sign of local and end organ injury. We did not observe these changes in NAC performed group thus showing the efficacy of NAC.Öğe Surgical management of iatrogenic femoral artery pseudoaneurysms: A 10-year experience(Lithographia, 2013) Huseyin, S.; Yuksel, V; Sivri, N.; Gur, O.; Gurkan, S.; Canbaz, S.; Ege, T.Background: Vascular complications of cardiac catheterization have increased in line with increasing number of percutaneous interventions. Open repair is the standard method of treatment for true and false aneurysms of femoral artery. We report results of patients operated due to femoral artery pseudoaneurysm after cardiac catheterization. Methods: Data from 12,261 patients who underwent percutaneous intervention for cardiac catheterization between January 2003 and January 2013 were evaluated. Diagnosis of pseudoaneurysm was established mainly by doppler ultrasonography in patients with complaints of pain and hematoma at the intervention site. Pseudoaneurysms less than 2 cm in diameter were treated non-operatively and were followed up by regular ultrasonographic examination at the outpatient clinic. Pseudoaneurysms with a diameter of 2 cm or more underwent primary repair. All patients were followed up for one year. Results: We detected 55 (0.44%) patients with femoral artery pseudoaneurysm and 42 of them were operated. The mean age was 60.7 +/- 6.3 years. Thirty nine (94.5%) patients underwent elective surgery, three (5.5%) patients were operated on under emergency conditions. Operation was performed under local anesthesia in 32 patients, under local anesthesia and sedation in eight patients, and under general anesthesia in three patients. Location of the pseudoaneurysm was the superficial femoral artery in 29 (69%), the common femoral artery in nine (21.4%), and the deep femoral artery in four (9.6%) patients. No limb loss occurred, no patient died and no recurrence was detected during the follow up. Conclusions: Performing vascular reconstruction before the rupture of pseudoaneurysm is important in terms of morbidity and mortality. We concluded that surgical repair in pseudoaneurysms larger than 20 mm is safe and essential.Öğe The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting(Lippincott Williams & Wilkins, 2007) Arar, C.; Colak, A.; Alagol, A.; Uzer, S. S.; Ege, T.; Turan, N.; Duran, E.Background and Objective: The haemodynamic responses during extubation can cause complications after openheart surgery. In this study, we aimed to examine the effect of esmolol and magnesium before extubation on these haemodynamic responses. Methods: Following the approval of local Ethics Committee, 120 patients having coronary artery bypass grafting with extubation in the intensive care unit were included in the study. Patients were allocated to receive esmolol 1 mg kg(-1) (group 1, n = 40), magnesium 30 mg kg(-1) (Group 11, n = 40) or normal saline (Group 111, n = 40). Study medication was administered as a 20-min infusion in a volume of 20 mL. Patients were extubated just after termination of the infusion. Heart rate, blood pressure and central venous pressure were recorded prior to drug administration, before extubation, during extubation and I min after extubation. Results: Heart rate was lower in Group I than in Groups 11 (P < 0.05) and III (P < 0.001) and lower in Group 11 than in Group III (P < 0.05) during extubation. It was also lower in Group I than in Group III (P < 0.05) after extubation. Systolic blood pressure was lower in Group I than in Groups 11 and III (P < 0.001) during extubation. Diastolic blood pressure was higher in Group III than in Groups I and 11 during extubation (P < 0.001) and after extubation (P < 0.05). Mean arterial pressure was lower in Group I than in Groups 11 and III (P < 0.001) during extubation, lower in Group III than in Group III (P < 0.05) during extubation and lower in Group I than in Group III (P < 0.05) after extubation. Conclusion: We found that using esmolol before extubation following coronary artery bypass graft surgery prevents undesirable haemodynamic responses while magnesium reduces undesirable haemodynamic responses but does not prevent them.
