Publications by authors named "Cenk Ozpeker"

4 Publications

  • Page 1 of 1

Minimally invasive redo-aortic valve replacement.

Multimed Man Cardiothorac Surg 2018 Jan 30;2018. Epub 2018 Jan 30.

Medizinische Universität Innsbruck Anichstrasse 35 6020 Innsbruck Austria.

Bioprosthetic aortic valves have been used with increasing frequency over the past two decades, often in relatively young patients who may eventually require aortic valve re-operations due to degeneration of the bioprosthesis. Growing experience with minimally invasive aortic valve replacement has prompted surgeons to use minimally invasive approaches also with redo operations for replacement of the aortic valve.  This tutorial describes the operative steps for a minimally invasive redo replacement of the aortic valve through an upper ministernotomy. We demonstrate the surgical access, initiation of cardiopulmonary bypass, venting, and cardioplegia strategies. Special situations, such as how to approach patent coronary grafts, the small aortic annulus, and the use of sutureless or rapid deployment valves are demonstrated and discussed. The tutorial shows that minimally invasive redo aortic valve replacement is a safe, effective, and reproducible procedure.
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http://dx.doi.org/10.1510/mmcts.2018.010DOI Listing
January 2018

Ventricular assist devices in patients with chemotherapy-induced cardiomyopathy: new modalities.

Acta Cardiol 2015 Aug;70(4):430-4

Introduction: Cardiotoxicity is a fatal complication of chemotherapeutic agents in which the implantation of a mechanical circulatory support system (MCS) can be a life-saving modality. The aim of this article is to analyse this available therapeutic option for patients with cardiotoxicity induced by treatment of malignancy in the light of current literature. We analysed our recent experience with MCS implantations in patients who have advanced heart failure associated with chemotherapy-induced cardiotoxicity. Methods In the hospital registries of 386 adult cardiomyopathy patients who were supported with a long-term impantable MCS in our institution between January 2008 and June 2012, were retrospectively evaluated. In 11 of these patients (mean age ?SD years; overall %; female/male (n); 42 +/- 14, 2.8%, 4/7) MCS was implemented due to chemotherapeutic drug-induced cardiomyopathy (CDIC). Pre-operative and post-operative data of CDIC patients were analysed.

Results: In this cohort of CDIC patients, mean duration of circulatory support was 413 ?445 days. One of the patients was successfully bridged to heart transplantation (HTx) after exclusion of possible contraindications. In one patient, left ventricular assist device (LVAD) was successfully explanted after myocardial recovery. In the late post-operative period, five patients expired due to multi-organ failure and gastrointestinal haemorrhage. The remaining 4 patients are still under follow-up on LVAD-support. One of these patients was listed for high-urgency HTx because of device-related infection.

Conclusion: Cardiotoxicity leading to advanced heart failure is a serious complication of chemotherapeutic agents with a high risk of mortality. In our series LVAD therapy seems to be a beneficial and safe option. LVAD therapy is an acceptable option in chemotherapy-induced, advanced cardiomyopathy.
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http://dx.doi.org/10.1080/ac.70.4.3094652DOI Listing
August 2015

The biomarker plasma galectin-3 in advanced heart failure and survival with mechanical circulatory support devices.

J Heart Lung Transplant 2013 Feb;32(2):221-30

Heart and Diabetes Center NRW, Clinic of Thoracic and Cardiovascular Surgery, Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Bad Oeynhausen, Germany.

Background: During screening of heart transplantation (HTx) candidates supported by ventricular assist devices (VADs) for plasma biomarkers we found that galectin-3 (Gal-3) was increased pre-operatively in patients who later died during VAD support. Therefore, we analyzed the predictive value of plasma Gal-3 in the context of other potential clinical risk factors for death on device (DOD) in a cohort of 175 VAD patients.

Methods: We analyzed numerous clinical factors and plasma Gal-3 levels of 175 VAD patients before device implantation. Eighty VAD patients were successfully bridged to HTx (BTT, 45.7%), 80 (45.7%) died on VAD, 2 recovered on device (BTR, 1.1%) and 13 (7.4%) were still on device. Uni- and multivariate analyses were performed to assess the importance of Gal-3 with respect to other clinical factors. Myocardial gene expression of Gal-3 was investigated in apex samples by RT-PCR (n = 30) and Western blotting (n = 45).

Results: Plasma Gal-3 levels were higher in VAD patients than in controls (16.6 ± 9.3 vs 9.5 ± 3.9 ng/ml, p < 0.0001). Cox regression showed several clinical factors and type of VAD as independent outcome predictors, but Gal-3 was not among them. Using the regression equation we grouped patients according to their factor constellation for prediction of survival on VAD. We propose a calculation method for VAD survival prediction. Gal-3 mRNA and protein were detectable in failing myocardium, but did not correlate with its plasma concentration.

Conclusions: Galectin-3 levels are associated with severe heart failure but do not provide sufficient discrimination for prediction of outcomes after VAD implantation. Importantly, we were unable to confirm myocardial tissue as a primary source for the observed plasma elevations of Gal-3.
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http://dx.doi.org/10.1016/j.healun.2012.11.011DOI Listing
February 2013

Successful lung volume reduction surgery brings patients into better condition for later lung transplantation.

Eur J Cardiothorac Surg 2002 Sep;22(3):363-7

Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.

Objectives: Lung volume reduction surgery (LVRS) is accepted as a potential alternative therapy to lung transplantation (LTX) for selected patients. However, the possible impact of LVRS on a subsequent LTX has not been clearly elucidated so far. We therefore analyzed the course of 27 patients who underwent LVRS followed by LTX in our institution.

Methods: Twenty-seven patients (11 male, 16 female, mean age 51.9+/-2.2 years) out of 119 patients who underwent LVRS between 1994 and 1999 underwent LTX 29.7+/-3.2 months (range 2-57 months) after LVRS. Based on the postoperative course of FeV1 after LVRS (best value within the first 6 months postoperatively compared with the preoperative value) patients were divided into two groups: Group A (n=11) without any improvement (FeV1 <20% increase), and Group B (n=16) with FeV1 increase > or = 20% after successful LVRS which declined to preoperative values after 8-42 months. Subsequent LTX was performed 22.9+/-5.6 months after LVRS in Group A and 34.3+/-4.9 months after LVRS in Group B (P<0.05). Patients were analyzed according to the course of their functional improvement and of their body mass index (BMI) after LVRS and to survival after LTX, respectively. Values are given as the mean+/-SEM and significance was calculated by the chi(2)-test whereas continuous values were estimated by Student's t-test.

Results: Patients in Group A without improvement in FeV1 after LVRS had no increase in BMI as well and this resulted in a high perioperative mortality of 27.3% after LTX. On the contrary, patients in Group B, who had a clear increase of FeV1 after LVRS, experienced a significant increase of BMI of 23.2+/-4.5% as well (P<0.05). This improvement in BMI remained stable despite a later deterioration of FeV1 prior to LTX. After LTX, these patients had a significantly lower perioperative mortality of 6.3% as compared to Group A (P=0.03).

Conclusions: Successful LVRS delays the need for transplantation, improves nutritional status and brings patients into a better pretransplant condition, which results in decreased perioperative mortality at LTX. Patients after failed LVRS, however, should be considered as poor candidates for later transplantation.
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http://dx.doi.org/10.1016/s1010-7940(02)00354-8DOI Listing
September 2002