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    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.
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    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.
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    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.