Publications by authors named "Ahmet Baris Durukan"

52 Publications

Mini-endovascular aneurysm repair: a minimalist approach for a minimally invasive procedure.

Kardiochir Torakochirurgia Pol 2021 Mar 15;18(1):50-54. Epub 2021 May 15.

Department of Cardiovascular Surgery, Salihli Private MediGüneş Hospital, Salihli, Manisa, Turkey.

Introduction: Abdominal aortic aneurysms represent the majority of all aneurysms of the aorta. Endovascular aneurysm repair (EVAR) is an alternative procedure to surgical repair. Although general and regional anaesthesia are frequently used during EVAR procedures, local anaesthesia has become one of the anaesthesia options for which there is increasing experience.

Aim: We reported our EVAR cases in which we routinely used femoral local anaesthesia.

Material And Methods: Between August 2016 and June 2020, the EVAR procedure was applied to 22 infrarenal abdominal aortic aneurysm patients under femoral local anaesthesia. Open femoral artery access through a groin incision was used in all patients. Patients were followed up for graft- and wound-related complications.

Results: The mean age of the patients was 72.59 ±6.6 years (min: 60, max: 84). Mean aneurysm sac diameter was 61.04 ±8.76 mm. Bifurcated stent graft was used in 21 (95.5%) patients. An aorto-uni-iliac stent graft was used for 1 (4.5%) patient due to contralateral total iliac occlusion. Endoleak was observed in 6 patients. In-hospital mortality was observed in 2 patients; both cases were ruptured with haemodynamic instability (9%). Revision in the groin area was performed in 3 (13.6%) patients due to local wound complications.

Conclusions: Although the EVAR procedure has been described as a safer and more easily applicable alternative to surgical repair, it is disadvantageous in terms of increasing treatment costs. Anaesthesia preference and incision size with a more minimalist approach can reduce the length of hospital stay and minimize the complications that may occur after the procedure, resulting in decreased costs.
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http://dx.doi.org/10.5114/kitp.2021.105188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442085PMC
March 2021

Antiochus I Soter may have suffered from takotsubo cardiomyopathy due to unrequited love of Strotonikea in the perspective of modern medicine.

Kardiochir Torakochirurgia Pol 2021 Jun 5;18(2):117-118. Epub 2021 Jul 5.

Department of Archeology, Faculty of Language, History, and Geography, Ankara University, Ankara, Turkey.

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http://dx.doi.org/10.5114/kitp.2021.107475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340640PMC
June 2021

Evaluation of 3D printing in planning, practicing, and training for endovascular lower extremity arterial interventions.

Turk Gogus Kalp Damar Cerrahisi Derg 2021 Jan 13;29(1):20-26. Epub 2021 Jan 13.

Department of Cardiology, Medical Park İzmir Hospital, Izmir, Turkey.

Background: In this study, we aimed to investigate the potential role of 3D-printed physical and digital anatomical models in pre-procedural planning, practice and training in lower extremity arterial interventions.

Methods: A total of 16 patients (9 males, 7 females; mean age: 72.1±1.5 years; range, 69 to 75 years) who underwent superficial femoral artery balloon angioplasty between February 2016 and April 2019 were retrospectively reviewed for vascular access site preference and balloon sizing. Pre-procedural computed tomography volumetric images used for diagnosis were analyzed and modeled with 3D printing. Procedural and 3D-based data regarding the size of the balloon and deployment sites and the severity of the stenosis were compared.

Results: Measurements obtained from 3D models manually and segmentation images from software were similar (p>0.05). Both were smaller than the actual size of balloons used (p<0.001). Stenosis severity was similar with manual and software methods and both were significantly lower than the reported quantitative angiographic measurements (p<0.001). Vascular access site preference was changed in five (31.2%) patients, when the model was simulated by a non-sterile practice on 3D-printed physical models. The wire and catheter selection differed in eight patients, while practicing with models.

Conclusion: The planning and practicing of lower extremity arterial procedures with 3D models may reduce operator-dependent variables, avoid unnecessary interventions, reduce endothelial damage, and increase procedural success. The 3D-printed models may be used for educational purposes for medical professionals.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2021.20478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970071PMC
January 2021

Determination of acute changes in new electrocardiography parameters during veno-venous extracorporeal membrane oxygenation support.

Kardiochir Torakochirurgia Pol 2020 Dec 15;17(4):189-192. Epub 2021 Jan 15.

Bishkek Bicard Klinik, Bishkek, Kyrgyzstan.

Introduction: Veno-venous extracorporeal membrane oxygenation (ECMO) support has been used for respiratory insufficiency. Its role in blood oxygenation has been well documented. However, the effects on myocardial electrophysiology have not been studied in detail.

Aim: To reveal the acute effects of extracorporeal support on new electrocardiography (ECG) parameters in patients with preserved left ventricular functions.

Material And Methods: This retrospective study was conducted in three separate clinics. Sixteen consecutive patients under veno-venous ECMO for respiratory insufficiency who soon could be successfully weaned were analyzed. Immediately before and 2 hours after initiation of ECMO, ECG was performed. P wave, QT, QTc and T wave peak to end were measured and calculated from obtained surface 12-lead ECG.

Results: There were statistically significant differences immediately before and 2 hours after initiation of ECMO treatment in the Tp-e interval and Tp-e/QTc ratio, the maximum QTc, minimum QTc, and QTc dispersion values, and P wave dispersion ( < 0.0001 for each). All ECG parameters were significantly decreased with ECMO support.

Conclusions: All atrial and ventricular repolarization parameters were decreased in patients with VV-ECMO support. Despite the limited role of ECMO in intractable arrhythmias, the findings of the study revealed that ECMO therapy for respiratory insufficiency may improve atrial ventricular depolarization and repolarization. Therefore, simple 12-lead surface ECG with new ECG parameters may be evaluated for better outcomes.
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http://dx.doi.org/10.5114/kitp.2020.102333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848614PMC
December 2020

A novel method for cannulation of the short limb of aortic stent grafts during endovascular aneurysm repair: Göçer technique.

Turk Gogus Kalp Damar Cerrahisi Derg 2020 Oct 21;28(4):706-707. Epub 2020 Oct 21.

Department of Cardiovascular Surgery, Medical Park Uşak Hospital, Uşak, Turkey.

Cannulation of the shorter limb of an abdominal aortic endograft can be demanding. Confirmation of the accurate cannulation is equally challenging. Interventional cardiologists and cardiovascular surgeons may encounter certain difficulties during this procedure. In particular, cardiologists have a wide variety of experience in interventions from coronary practice. This novel method we describe herein consists of peripheral balloon usage in wiring the short limb of an aortic stent graft. In this method, an over-the-wire peripheral balloon is employed to centralize the wire at the gate of the short limb. The centralized wire in three-dimensional arterial lumen can cross the short limb of the graft easily.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2020.19817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759038PMC
October 2020

Safe carotid endarterectomy: "one fits all strategy".

Kardiochir Torakochirurgia Pol 2020 Sep 23;17(3):137-142. Epub 2020 Sep 23.

Department of Cardiovascular Surgery, Medical Park Usak Hospital, Usak, Turkey.

Introduction: Carotid artery stenosis of 50% or more in the extracranial internal carotid artery is responsible for 10-15% of all strokes. Interventional treatment options include carotid endarterectomy and carotid artery stenting, where endarterectomy is proven to be superior.

Aim: In this study, we report the carotid endarterectomy results of patients we operated on using the strategy we termed the "one fits all strategy".

Material And Methods: Seventy-six patients undergoing carotid endarterectomy between July 2016 and April 2020 were retrospectively studied. Conventional endarterectomy under general anesthesia with primary closure of the arteriotomy was performed in all patients. We used a near infrared spectroscopy oximeter to measure regional cerebral oxygenation continuously throughout the surgery.

Results: The mean age of the patients was 70.96 8.15 years. There were 52 male and 24 female patients. The mean follow-up time was 20.6 ±13.6 months. Coronary artery disease was detected in 52 (73.6%) patients. Coronary artery bypass operation was indicated in 19 patients in whom a staged approach was performed in 13 and a reverse staged approach in 1. There were two perioperative strokes one of which recovered fully spontaneously and the other partially with physiotherapy. Eight cases were revised due to hematoma formation.

Conclusions: Carotid endarterectomy continues to prove its safety in carotid artery stenosis patients. Continuous cerebral oxygenation monitoring is indispensable for carotid surgery. Despite discrepancies in surgical techniques, we believe that "one fits all strategy: general anesthesia, conventional endarterectomy without patch plasty, never shunter and always NIRS monitorization" may be used safely in patients undergoing carotid endarterectomy.
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http://dx.doi.org/10.5114/kitp.2020.99077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526482PMC
September 2020

Evaluation of 3D printed carotid anatomical models in planning carotid artery stenting.

Turk Gogus Kalp Damar Cerrahisi Derg 2019 Jun 22;28(2):294-300. Epub 2020 Apr 22.

Department of Cardiology, Medical Park Izmir Hospital, Izmir, Turkey.

Background: We aimed to investigate the potential role of threedimensional printed anatomical models in pre-procedural planning, practice, and selection of carotid artery stent and embolic protection device size and location.

Methods: A total of 16 patients (10 males, 6 females; mean age 75.6±4.7 years; range, 68 to 81 years) who underwent carotid artery stenting with an embolic protection device between January 2017 and February 2019 were retrospectively analyzed. The sizing was based on intraprocedural angiography findings with the same brand stent using distal protection device. Pre-procedural computed tomography angiography images used for diagnosis were obtained and modeled with three-dimensional printing method. Pre-procedural and threedimensional data regarding the size of stents and protection devices and implantation sites were compared.

Results: Measurements obtained from three-dimensional models manually and segmentation images from software were found to be similar and both were smaller than actually used for stent and embolic protection device sizes. The rates of carotid artery stenosis were similar with manual and software methods, but were lower than the quantitative angiographic measurements. Device implantation sites detected by the manual and software methods were different than the actual setting.

Conclusion: The planning and practicing of procedure with threedimensional models may reduce the operator-dependent variables, shorten the operation time, decrease X-ray exposure, and increase the procedural success.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2020.18939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7298382PMC
June 2019

A Novel Method to Adjust Saphenous Vein Graft Lengths Using 3D Printing Models.

Heart Surg Forum 2020 03 16;23(2):E135-E139. Epub 2020 Mar 16.

Medical Park İzmir Hospital, Department of Cardiology, İzmir, Turkey.

Background: The optimal length of saphenous vein grafts can be challenging in surgical coronary revascularization. It is the cornerstone for graft patency. In this study, we tried to demonstrate the value of 3D printing in determining optimal saphenous graft length.

Methods: Sixteen patients who underwent bypass surgery with only vein grafts were examined. Patients' measurements of graft lengths were obtained from postoperative CT images and from both 3D print models manually with plastic tubes and via 3D print digital images of Mimics software during segmentation. Another measurement was done using the Fit Centerline tool in the analysis module of Mimics software after segmentation. These 3 measurements were compared.

Results: There was a statistically significant difference between 3 measurement methods for each graft length (P < .001). Measurements of actual grafts were longer than measurements of 3D printed models manually and segmentation images from software were similar (P > .05).

Conclusion: 3D printing models and their software may be used to determine optimal saphenous graft length and the anastomosis site to decrease operation time. It can be deducted from these results that 3D printing is a promising method for reducing operator dependent variables in adjusting graft size and finding optimal anastomosis sites.

Introduction:
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http://dx.doi.org/10.1532/hsf.2765DOI Listing
March 2020

Comparison of P-Wave Duration and Dispersion in Mitral Valve Replacement Surgery Via Right Atrial Transseptal or Left Atrial Approach in Rheumatic Mitral Stenosis Patients.

Heart Surg Forum 2020 03 11;23(2):E118-E122. Epub 2020 Mar 11.

Department of Cardiovascular Surgery, Bicard Clinic, Bishkek, Krygyzystan.

Background: Predisposition to atrial fibrillation in mitral valve surgery has been well demonstrated. The changes in electrocardiographic parameters (Pmax, Pmin and P-wave dispersion) related to AF risk are unknown. We aimed to document the relationship between electrocardiographic changes and mitral valve replacement through right or left atrial surgical approaches.

Methods: We retrospectively studied 154 patients, who underwent mitral valve replacement surgery from 2008 to 2018. Seventy-nine patients were operated with right atriotomy and transseptal approach (Group 1), and 75 patents were operated with left atriotomy (Group 2). ECGs obtained at hospital admittance and postoperatively at 24 hours were blindly analyzed.

Results: Preoperative demographic characteristics were similar. Pmax, Pmin and P-wave dispersion were similar preoperatively. All parameters increased in both groups compared with the preoperative values (P < .05). Postoperative Pmax, Pmin and P-wave dispersion all were statistically significantly higher with the right atrial approach (P < .05). Postoperative AF also was more common in Group 1 (P < .05).

Conclusion: Right atrial approach may lead to higher P-wave changes and atrial arrhythmias. This may be due to more extensive surgical disruption. The changes in atrial anatomic structure can increase atrial arrhythmic propensity and can cause atrial fibrillation.
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http://dx.doi.org/10.1532/hsf.2667DOI Listing
March 2020

Closure of an acquired aortocoronary venous fistula after coronary artery bypass grafting causing heart failure and stable angina: A case report.

Turk Gogus Kalp Damar Cerrahisi Derg 2019 Oct 23;27(4):580-582. Epub 2019 Oct 23.

Department of Cardiovascular Surgery, MedicalPark Uşak Hospital, Uşak, Turkey.

Iatrogenic aortocoronary venous fistula arising from anastomosing an aortocoronary graft to a cardiac vein is a rare a complication following coronary artery bypass grafting. A 75-year-old male patient was admitted with recurrent angina accompanied by congestive heart failure six years after surgery. He was diagnosed with an acquired saphenous vein graft-to- cardiac vein fistula. Based on the estimation of risks versus benefits, the heart team decided to perform percutaneous closure with a vascular occlusion device. Subsequently, complaints and echocardiographic findings of the patient resolved.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2019.18381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018147PMC
October 2019

The cytotoxic properties and apoptotic potential of N-butyl and 2-octyl cyanoacrylates used in surgical treatment of chronic venous insufficiency.

Turk Gogus Kalp Damar Cerrahisi Derg 2019 Apr 24;27(2):185-191. Epub 2019 Apr 24.

Department of Biology, Hacettepe University Faculty of Science, Ankara, Turkey.

Background: This study aims to investigate the cytotoxic effects and apoptotic potential of N-butyl cyanoacrylate and 2-octyl cyanoacrylate used in surgical treatment of chronic venous insufficiency.

Methods: N-butyl cyanoacrylate and 2-octyl cyanoacrylate were cultured in cell-culture using human umbilical endothelial cell-line. Cytotoxicity and viability were assessed at 24 and 72 hours with lactate dehydrogenase and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays, respectively. Apoptotic potential was documented at 24 and 72 hours with relative caspase-3 activity.

Results: The mean cytotoxicity at 24 and 72 hours were: N-butyl cyanoacrylate with an area of dot/line: 37.0±3.9%/29.3±2.7% and 46.4±1.6%/45.1±7.1%, 2-octyl cyanoacrylate with an area of dot/line: 39.0±7.0%/37.3±4.6% and 47.0±2.3%/40.7±7.5%. Cytotoxicity increased by time in each group (p<0.05). The mean viability at 24 and 72 hours were: N-butyl cyanoacrylate with an area of dot/line: 53.4±7.7%/72.0±5.7% and 35.7±1.9%/37.8±3.7%, 2-octyl cyanoacrylate with an area of dot/line: 54.3±4.4%/73.5±19.9% and 33.6±2.8%/30.7±4.5%. The mean viability decreased by time in each group (p<0.05). The mean relative caspase-3 activity at 24 and 72 hours were: control group: 0.084±0.006 and 0.065±0.002, N-butyl cyanoacrylate with an area of dot/line: 0.940±0.037/0.924±0.053 and 0.999±0.072/1.056±0.015, 2-octyl cyanoacrylate with an area of dot/line: 0.900±0.044/0.928±0.018 and 0.989±0.084/0.999±0.072. The mean relative caspase-3 activity was higher than control group in each group at each time interval (p<0.05) and activity increased by time in N-butyl cyanoacrylate line and in 2-octyl cyanoacrylate line groups (p<0.05).

Conclusion: Our findings indicate that N-butyl cyanoacrylate and 2-octyl cyanoacrylate cause cytotoxicity in cell-culture media. We may also postulate that they induce apoptosis in cell-culture media.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2019.17091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021408PMC
April 2019

Effects of N-acetyl cysteine, vitamin E and vitamin C on liver glutathione levels following amiodarone treatment in rats.

Kardiochir Torakochirurgia Pol 2019 Jul 28;16(2):88-92. Epub 2019 Jun 28.

Department of Cardiology, Faculty of Science, Hacettepe University, Ankara, Turkey.

Introduction: Amiodarone, a pharmaceutical extensively used to suppress atrial and ventricular tachyarrhythmias, is also known to cause many side effects on many tissues. N-acetyl-cysteine (NAC), vitamin E and vitamin C are known as antioxidants for their ability to minimize oxidative stress. In the peer-reviewed literature, there is no study reporting on the protective effects of these antioxidant agents against its hepatotoxicity.

Aim: We investigated the oxidative effects of NAC, vitamins E and C on liver tissue after amiodarone treatment.

Material And Methods: Rats were randomly assigned to: control; amiodarone group; amiodarone + NAC treated group; amiodarone + Vit. E group and amiodarone + Vit. C group. Liver tissues were isolated from animals and total glutathione levels were measured.

Results: In all time intervals, the level of glutathione increased. When all time intervals were compared, the amiodarone group revealed the lowest levels. The antioxidant co-administered group was studied; the glutathione levels were statistically significantly higher than the sole amiodarone group. When vitamins E, C or N-acetyl cysteine were examined, there was no statistically significant difference among them.

Conclusions: In this study we found that hepatotoxicity capacity of amiodarone may be reduced by taking up antioxidants. In addition, the effect documented here may be reproducible and may be applied to clinical settings.
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http://dx.doi.org/10.5114/kitp.2019.86361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6690152PMC
July 2019

Carotid baroreceptor activation therapy for resistant hypertension and heart failure: a report of two cases.

Kardiochir Torakochirurgia Pol 2018 Sep 24;15(3):200-203. Epub 2018 Sep 24.

Department of Cardiovascular Surgery, Medical Park Usak Hospital, Usak, Turkey.

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http://dx.doi.org/10.5114/kitp.2018.78447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180017PMC
September 2018

Effects of propolis on warfarin efficacy.

Kardiochir Torakochirurgia Pol 2017 Mar 31;14(1):43-46. Epub 2017 Mar 31.

Department of Biology, Faculty of Science, Hacettepe University, Ankara, Turkey.

Introduction: Warfarin is commonly used to avoid thromboembolism, predominantly for cardiovascular pathologies. However, the consumption of several herbal products is not permitted during its use due to the associated interactions. Propolis is a popular phytotherapy product made by honey bees. The use of propolis has been dramatically increasing in recent times.

Aim: To evaluate the possible interactions between propolis and warfarin in a mouse model with determination of the international normalized ratio (INR) values.

Material And Methods: CD-1 mice were employed in the experimental model. The mice were warfarinized, and propolis was administered simultaneously. The INR values were obtained. All animals were sacrificed at the end of the study.

Results: The baseline INR value was 0.8 ±0.1. After 72 h, the INR value increased as expected. The INR value was 7.28 ±1.08 in the control group and 5.8 ±2.88 in the propolis group. At the end of the study, the INR value was 1.3 ±0.37. Propolis interacted with warfarin and caused a decrease in the INR value.

Conclusions: Propolis interactions, especially with warfarin, should be kept in mind and further studied. Healthcare specialists should be aware of this possible interaction between warfarin and propolis and inform patients about it.
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http://dx.doi.org/10.5114/kitp.2017.66929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404127PMC
March 2017

Electrical failure during cardiopulmonary bypass: a critical moment.

Kardiochir Torakochirurgia Pol 2016 Jun 30;13(2):143-4. Epub 2016 Jun 30.

Department of Cardiovascular Surgery, Memorial Ankara Hospital, Ankara, Turkey.

Electrical failure during cardiopulmonary bypass is a crisis situation for the cardiac surgical team. Fortunately, it has a low incidence with low morbidity and mortality rates. Notwithstanding, institutional preventative and management measures should be taken. Here, we report a case of electrical failure during cardiopulmonary bypass, which was successfully managed during the surgery, allowing the patient to recover uneventfully. These unwanted complications can only be managed by promoting awareness and putting in place strategies against them.
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http://dx.doi.org/10.5114/kitp.2016.61049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971270PMC
June 2016

Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions.

J Tehran Heart Cent 2015 8;10(1):43-5. Epub 2015 Jan 8.

Medicana International Ankara Hospital, Department of Cardiovascular Surgery, Ankara, Turkey.

Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494518PMC
July 2015

Author's reply.

Anadolu Kardiyol Derg 2014 Sep;14(6):564

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September 2014

Insufficiencies of downsizing ring annuloplasty in treatment of functional ischemic mitral regurgitation.

J Thorac Cardiovasc Surg 2014 Oct;148(4):1770-1

Department of Cardiovascular Surgery, Gulhane Military Medical Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.jtcvs.2014.06.034DOI Listing
October 2014

Skill acquisition process in vascular anastomosis procedures: a simulation-based study.

Eur J Cardiothorac Surg 2015 May 26;47(5):812-8. Epub 2014 Jul 26.

Department of Cardiovascular Surgery, Gülhane Military Medical Academy, Ankara, Turkey.

Objectives: There is growing evidence that practice on simulation models can improve technical skills in surgery. The aim of this study is to assess the effects of our tissue-based simulation model of vascular anastomosis on skill acquisition.

Methods: Five junior (Group I) and five senior (Group III) cardiovascular surgery residents, and five surgeons from different surgical departments (Group II) attended the study. A total of 180 vascular anastomoses on a bovine heart simulation model were performed in a 3-month period; each group performed 20 anastomoses per month (each participant in each group conducted four anastomoses per month). The anastomoses were evaluated according to criteria including, duration of the procedure, existence of anastomotic leak, additional suture requirements, matching between graft diameter and arteriotomy length, patency rates and inadvertent posterior wall injuries. Each practice was recorded with a video camera and eventually reviewed by three cardiovascular surgeons, who were blinded to groups. Results were compared for analysing the skill acquisition process in each group.

Results: The mean anastomosis time (Group I: 22.25 ± 2.02, 18.10 ± 0.78, 15.00; Group II: 17.05 ± 1.39, 15.45 ± 0.82, 13.00 ± 0.79; Group III: 13.65 ± 0.67, 11.45 ± 1.14, 10.50 ± 1.10) and additional suture requirements (Group I: 1.95 ± 0.68, 1.30 ± 0.80, 1.00 ± 0.32; Group II: 1.80 ± 0.41, 1.45 ± 0.60, 1.45 ± 0.60; Group III: 0.65 ± 0.48, 0.40 ± 0.50, 0.40 ± 0.50) decreased gradually (P < 0.0001 for each) in all groups. There was statistically significant improvement over time in anastomotic leakage (Group I: 90, 65, 20%; Group II: 50, 25, 5%; Group III: 20, 25, 5%), match between the arteriotomy and the graft (Group I: 35, 25, 75%; Group II: 60, 45, 85%; Group III: 85, 65, 95%), posterior wall injury (Group I: 70, 50, 15%; Group II: 50, 30, 5%; Group III: 30, 30, 5%) and patency (Group I: 45, 15, 75%; Group II: 60, 50, 95%; Group III: 80, 85, 95%) in all groups, except for the occurrence of anastomotic leaks and patency rates in the senior cardiovascular resident group (Group III).

Conclusions: Although the most significant improvement was observed in Group I, all groups demonstrated improved skills with the simulation model. Therefore, it can be suggested that anastomosis training on tissue-based simulation models may be beneficial for the skill acquisition process.
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http://dx.doi.org/10.1093/ejcts/ezu288DOI Listing
May 2015

Obesity is still a risk factor in coronary artery bypass surgery.

Anadolu Kardiyol Derg 2014 Nov 2;14(7):631-7. Epub 2014 Jan 2.

Clinic of Cardiovascular Surgery, Medicana International Ankara Hospital; Ankara-Turkey.

Objective: Even with the improvements in surgical techniques and perioperative care, obesity is still a risk factor for occurrence of adverse events following cardiac surgery. In this observational, retrospective study, we aimed to document the effects of obesity on surgical outcomes in patients undergoing coronary artery bypass surgery and find out the effects of improvements in cardiac surgery.

Methods: Between January 2011 and March 2013, isolated coronary artery bypass surgery was performed on 790 patients. The body mass index values of the patients were calculated and patients were divided into two groups; below 30 were classified as non-obese group whereas above 30 were classified as obese group. The odds ratio was obtained by using univariate analysis in order to document the effects of obesity on outcomes.

Results: There were 548 (69.3%) patients in non-obese group, whereas 242 (30.7%) patients in obese group. The cardiopulmonary bypass (80.47±23.58 vs. 80.89±28.46, p=0.449) and aortic clamp times (54.13±16.60 vs. 54.19±19.85, p=0.511) and number of bypass grafts (3.09±1.02 vs. 2.96±1.00, p=0.11) were comparable between the groups. The mean number of fresh frozen plasma used was higher in obese patients (1.37±1.75 vs. 1.48±4.63, p=0.02). Intubation time was higher in obese patients (10.57±6.87 vs. 12.71±35.31, p=0.014). Total amount of postoperative drainage was higher in non-obese patients (766.77±472.27 vs. 648.72±371.39, p<0.001). The superficial infection/mediastenitis (0.4% vs. 2.5%, p=0.012), dehiscence (0.2% vs. 3.7%, p<0.001) and postoperative renal failure rates (4.7% vs. 8.7%, p=0.031) were higher in obese patients. The incidence of atrial fibrillation was lower in obese patients (19.7% vs. 12.8%, p=0.019). The mortality (0.5% vs. 1.7%, p=0.210) and postoperative stroke rates (1.1% vs. 0.8%, p=1.000) were similar in both groups.

Conclusion: We documented that obesity is still a risk factor for occurrence of postoperative adverse events. We believe that improved perioperative care together with meticulous regimens can improve postoperative outcomes in patients undergoing coronary artery bypass surgery.
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http://dx.doi.org/10.5152/akd.2014.4954DOI Listing
November 2014

Response to letter to the editor: If watching were enough, the cats would be butchered.

J Surg Educ 2014 Jan-Feb;71(1). Epub 2013 Aug 6.

Department of Cardiovascular Surgery, Children's National Heart Institute, Children's National Medical Center, Washington, DC.

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http://dx.doi.org/10.1016/j.jsurg.2013.06.007DOI Listing
September 2015

Dehiscence of a composite aortic graft and pseudoaneursym late after a bentall operation.

J Tehran Heart Cent 2013 Jul 30;8(3):167-8. Epub 2013 Jul 30.

Medicana International Ankara Hospital, Department Of Cardiovascular Surgery, Ankara, Turkey.

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July 2013

Biological glue application in repair of atrioventricular groove rupture: a case report.

J Tehran Heart Cent 2014 3;9(3):137-9. Epub 2014 Jul 3.

Medicana International Ankara Hospital, Ankara, Turkey.

Atrioventricular groove rupture is a rare, albeit mortal, complication following mitral valve surgery. Avoidance is the best strategy but it cannot fully prevent the occurrence of this complication. Several repair techniques have been described with varying success rates; however, the rarity of the complication precludes consensus about the safest technique. Here we report two cases of posterior atrioventricular groove rupture. Both cases were diagnosed immediately after the cessation of cardiopulmonary bypass. Repair was performed successfully with a technique involving the use of biological glue. The postoperative course was uneventful for both of them. Both cases are well with normally functioning mitral prostheses; one with a follow-up time of 5.5 years and the other 10 months. We believe that the glue provides additional hemostasis and support to the repaired area.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393838PMC
April 2015

Ventilation during cardiopulmonary bypass did not attenuate inflammatory response or affect postoperative outcomes.

Cardiovasc J Afr 2013 Jul;24(6):224-30

Department of Cardiovascular Surgery, Medicana International Ankara Hospital, Ankara, Turkey.

Introduction: Cardiopulmonary bypass causes a series of inflammatory events that have adverse effects on the outcome. The release of cytokines, including interleukins, plays a key role in the pathophysiology of the process. Simultaneously, cessation of ventilation and pulmonary blood flow contribute to ischaemia-reperfusion injury in the lungs when reperfusion is maintained. Collapse of the lungs during cardiopulmonary bypass leads to postoperative atelectasis, which correlates with the amount of intrapulmonary shunt. Atelectasis also causes post-perfusion lung injury. In this study, we aimed to document the effects of continued low-frequency ventilation on the inflammatory response following cardiopulmonary bypass and on outcomes, particularly pulmonary function.

Methods: Fifty-nine patients subjected to elective coronary bypass surgery were prospectively randomised to two groups, continuous ventilation (5 ml/kg tidal volume, 5/min frequency, zero end-expiratory pressure) and no ventilation, during cardiopulmonary bypass. Serum interleukins 6, 8 and 10 (as inflammatory markers), and serum lactate (as a marker for pulmonary injury) levels were studied, and alveolar- arterial oxygen gradient measurements were made after the induction of anaesthesia, and immediately, one and six hours after the discontinuation of cardiopulmonary bypass.

Results: There were 29 patients in the non-ventilated and 30 in the continuously ventilated groups. The pre-operative demographics and intra-operative characteristics of the patients were comparable. The serum levels of interleukin 6 (IL-6) increased with time, and levels were higher in the nonventilated group only immediately after discontinuation of cardiopulmonary bypass. IL-8 levels significantly increased only in the non-ventilated group, but the levels did not differ between the groups. Serum levels of IL-10 and lactate also increased with time, and levels of both were higher in the non-ventilated group only immediately after the discontinuation of cardiopulmonary bypass. Alveolar-arterial oxygen gradient measurements were higher in the non-ventilated group, except for six hours after the discontinuation of cardiopulmonary bypass. The intubation time, length of stay in intensive care unit and hospital, postoperative adverse events and mortality rates were not different between the groups.

Conclusion: Despite higher cytokine and lactate levels and alveolar-arterial oxygen gradients in specific time periods, an attenuation in the inflammatory response following cardiopulmonary bypass due to low-frequency, low-tidal volume ventilation could not be documented. Clinical parameters concerning pulmonary and other major system functions and occurrence of postoperative adverse events were not affected by continuous ventilation.
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http://dx.doi.org/10.5830/CVJA-2013-041DOI Listing
July 2013

Is double-blinding possible while administering fluids in the intensive care unit?

Cardiovasc J Afr 2013 May;24(4):136

Department of Cardiovascular Surgery, Medicana International Ankara Hospital, Ankara, Turkey.

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May 2013

Three-dimensional configuration of the mitral subvalvular apparatus.

J Thorac Cardiovasc Surg 2013 Nov;146(5):1308-9

Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Diyarbakir, Turkey.

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http://dx.doi.org/10.1016/j.jtcvs.2013.05.052DOI Listing
November 2013

The fanfolding modification for removing chest tube clogging after cardiac surgery.

Eur J Cardiothorac Surg 2014 Mar 3;45(3):589. Epub 2013 Jul 3.

Department of Cardiovascular Surgery, Diyarbakir Military Medical Hospital, Diyarbakir, Turkey.

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http://dx.doi.org/10.1093/ejcts/ezt340DOI Listing
March 2014

eComment. Is retrograde autologous priming effective on cerebral functions and haematocrit levels?

Interact Cardiovasc Thorac Surg 2013 Jun;16(6):783; discussion 783

Department of Cardiovascular Surgery, Medicana International Ankara Hospital, Ankara, Turkey.

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http://dx.doi.org/10.1093/icvts/ivt168DOI Listing
June 2013
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