Publications by authors named "Mustafa Vayvada"

14 Publications

  • Page 1 of 1

Lung Transplantation for Cystic Fibrosis in Turkey: First Report.

Exp Clin Transplant 2021 Feb 17. Epub 2021 Feb 17.

From the Department of Thoracic Surgery, Kartal Kosuyolu Training and Research Hospital, Istanbul, Turkey.

Objectives: Lung transplant is the most important treatment approach that improves the life expectancy and quality of life for patients with cystic fibrosis with end-stage lung disease. In this study, we retros-pectively analyzed patients with cystic fibrosis who were referred to our lung transplant program in Turkey.

Materials And Methods: We evaluated 14 patients with cystic fibrosis who were referred to our lung transplant clinic between December 2016 and December 2019. The characteristics of the patients at the time of referral to our lung transplant clinic, survival, and lung transplant results were recorded.

Results: Four patients died on the wait list, 3 patients were not eligible for lung transplant, and lung transplant was performed in 7 patients. The mean age of all patients was 22.8 years (range, 11-41 years), and the mean age for patients who underwent lung transplant was 27.5 years (range, 21-41 years). The mean time of suitable donor offer or survival life was 140 days in the patients who were referred for lung transplant. The 1-year mortality rate was 28.6% (2 of 7 patients) after lung transplant. One patient died of chronic lung allograft dysfunction at the 25th month after lung transplant. Four patients were alive without any problems.

Conclusions: Lung transplant is the final treatment method for patients with cystic fibrosis with terminal period lung disease. To provide the best benefit, patients should be evaluated for transplant early. Cystic fibrosis care clinics and lung transplant clinics should work in coordination in order to increase the number of lung transplants and improve outcomes.
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http://dx.doi.org/10.6002/ect.2020.0282DOI Listing
February 2021

Delayed Chest Closure for Oversized Lung Allograft in Lung Transplantation: a Retrospective Analysis from Turkey.

Braz J Cardiovasc Surg 2021 Feb 1. Epub 2021 Feb 1.

Department of Thoracic Surgery, University of Health Sciences Kartal Kosuyolu Yuksek Ihtisas Hospital, Istanbul, Turkey.

Introduction: The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation.

Methods: Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared.

Results: The mean age was 44.5 years. There was no significant difference between the demographics of the groups (P>0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs. 0.96, P=0.008). Extubation time (4.3 vs. 3.1 days, P=0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P=0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P=0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P=0.300).

Conclusion: DCC is a safe and effective method for the management of OLA in lung transplantation.
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http://dx.doi.org/10.21470/1678-9741-2020-0299DOI Listing
February 2021

Lung transplantation for graft-versus-host disease after allogeneic stem cell transplantation: A report of two cases.

Turk Gogus Kalp Damar Cerrahisi Derg 2020 Jul 28;28(3):543-546. Epub 2020 Jul 28.

Department of Thoracic Surgery, University of Health Sciences, Kartal Koşuyolu Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.

Allogeneic peripheral stem cell transplantation is an effective treatment of malignant and non-malignant hematological diseases. However, it is associated with several complications, such as graft-versus-host disease, and also various complications involving different organ systems. Late-onset non-infectious lung complication is one of them. This pathology may also affect the different anatomical regions in the lung as parenchymas, bronchi, or vessels and may manifest with different clinical presentations. Lung transplantation can be an effective treatment in patients with pulmonary complications after allogeneic stem cell transplantation and also in patients who do not respond to treatment adequately and with a limited life expectancy. Herein, we report two rare cases who underwent lung transplantation after allogeneic stem cell transplantation.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2020.19009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493612PMC
July 2020

Extracorporeal membrane oxygenation as a bridge to lung transplantation in a Turkish lung transplantation program: our initial experience.

J Artif Organs 2021 Mar 27;24(1):36-43. Epub 2020 Aug 27.

Thoracic Surgery, Kartal Kosuyolu Training and Research Hospital, K Blok Cevizli, Kartal, Istanbul, Turkey.

Lung transplantation is a life-saving treatment for patients with end-stage lung disease. Although the number of lung transplants has increased over the years, the number of available donor lungs has not increased at the same rate, leading to the death of transplant candidates on waiting lists. In this paper, we presented our initial experience with the use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. Between December 2016 and August 2018, we retrospectively reviewed the use of ECMO as a bridge to lung transplantation. Thirteen patients underwent preparative ECMO for bridging to lung transplantation, and seven patients successfully underwent bridging to lung transplantation. The average age of the patients was 45.7 years (range, 19-62 years). The ECMO support period lasted 3-55 days (mean, 18.7 days; median, 13 days). In seven patients, bridging to lung transplantation was performed successfully. The mean age of patients was 49.8 years (range 42-62). Bridging time was 3-55 days (mean, 19 days; median, 13 days). Two patients died in the early postoperative period. Five patients survived until discharge from the hospital. One-year survival was achieved in four patients. ECMO can be used safely for a long time to meet the physiological needs of critically ill patients. The use of ECMO as a bridge to lung transplantation is an acceptable treatment option to reduce the number of deaths on the waiting list. Despite the successful results achieved, this approach still involves risks and complications.
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http://dx.doi.org/10.1007/s10047-020-01204-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450232PMC
March 2021

Combined Off-Pump Coronary Artery Bypass Grafting and Lung Resection in Patients with Lung Cancer Accompanied by Coronary Artery Disease.

Braz J Cardiovasc Surg 2018 Sep-Oct;33(5):483-489

Yuzuncu Yil University School of Medicine Gaziosmanpasa Hospital, Department of Thoracic Surgery, Istanbul, Turkey.

Introduction: Optimal surgical approach for the treatment of resectable lung cancer accompanied by coronary artery disease (CAD) remains a contentious issue. In this study, we present our cases that were operated simultaneously for concurrent lung cancer and CAD.

Methods: Simultaneous off-pump coronary artery bypass surgery (OPCABG) and lung resection were performed on 10 patients in our clinic due to lung cancer accompanied by CAD. Demographic features of patients, operation data and postoperative results were evaluated retrospectively.

Results: Mean patient age was 63.3 years (range 55-74). All patients were male. Six cases of squamous cell carcinoma, three of adenocarcinoma and one case of large cell carcinoma were diagnosed. Six patients had single-vessel CAD and 4 had two-vessel CAD. Three patients underwent OPCABG at first and then lung resection. The types of resections were one right pneumonectomy, three right upper lobectomies, one right lower lobectomy, three left upper lobectomies, and two left lower lobectomies. Reoperation was performed in one patient due to hemorrhage. One patient developed intraoperative contralateral tension pneumothorax. One patient died due to acute respiratory distress syndrome at the early postoperative period.

Conclusion: Simultaneous surgery is a safe and reliable option in the treatment of selected patients with concurrent CAD and operable lung cancer.
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http://dx.doi.org/10.21470/1678-9741-2018-0126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6257540PMC
March 2019

Correlation between meteorological changes and primary spontaneous pneumothorax: Myth or fact?

Turk Gogus Kalp Damar Cerrahisi Derg 2018 Jul 3;26(3):436-440. Epub 2018 Jul 3.

Department of Thoracic Surgery, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey.

Background: This study aims to investigate the relationship between meteorological changes and the development of primary spontaneous pneumothorax.

Methods: Medical records of 1,097 patients ( 975 males, 122 females; mean age 23.5±4.2 years; range, 17 to 32 years) admitted to our hospital with a diagnosis of primary spontaneous pneumothorax between January 2010 and January 2014 were evaluated retrospectively. Daily mean values for air temperature, wind speed, humidity rate and atmospheric pressure values obtained from the local meteorological observatory were recorded. The four-year study period was separated into two groups as days with at least one primary spontaneous pneumothorax development (group 1) and days without any primary spontaneous pneumothorax development (group 2).

Results: Within the study period of a total of 1,461 days, 1,097 cases were recorded in 759 days during which primary spontaneous pneumothorax was observed. Eighty-nine percent of the patients were male. There was no significant difference between the groups in terms of mean air temperature, humidity rate, and wind speed. Atmospheric pressure was significantly lower in group 1 (p<0.001). Decrease in atmospheric pressure with respect to the previous day increased the risk of primary spontaneous pneumothorax development significantly (p<0.001).

Conclusion: In our study, low atmospheric pressure and significant pressure decreases showed a strong correlation with primary spontaneous pneumothorax. Temperature, wind speed, and humidity values did not influence primary spontaneous pneumothorax development.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2018.15494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018269PMC
July 2018

Comparison of Mid-Term Clinical Outcomes of Different Surgical Approaches in Symptomatic Diaphragmatic Eventration.

Ann Thorac Cardiovasc Surg 2016 Aug 14;22(4):224-9. Epub 2016 Apr 14.

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Purpose: There is no data comparing different surgical techniques for diaphragmatic re-positioning for hemi-diaphragmatic eventration in adults. Our aim was to verify the potential pros and cons of two major surgical techniques in symptomatic eventration patients.

Methods: Patients undergoing thoracotomy for diaphragmatic elevation repair either by un-opened (accordion placation) or by opened (double-breasted placation) diaphragmatic technique between January 2007 and August 2013 were analyzed retrospectively, and compared in terms of operative outcomes on 12th and 24th months.

Results: Forty-two patients underwent accordion (n = 23) or double-breasted (n = 19) plication. Postoperative drainage was significantly increased (215 ± 66 ml vs. 114 ± 48 ml; P = 0.0082) in double-breasted group. Although the corrected diaphragm was radiologically better preserved in this group, this divergence showed no additional effect on postoperative pulmonary functions or the dyspnea score on 12th or 24th months. No complication particularly related to both techniques or recurrence was noted during follow-up of 28 ± 12 months.

Conclusions: Radiological prospect of corrected diaphragm is better preserved with double-breasted plication, but the significant and permanent improvement of respiratory functions was similar. Since the clinical outcome is equivalent, incision of the diaphragm is not essential.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045849PMC
http://dx.doi.org/10.5761/atcs.oa.16-00018DOI Listing
August 2016

Reply.

Ann Thorac Surg 2016 Mar;101(3):1243

Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.athoracsur.2015.09.061DOI Listing
March 2016

Double segmentectomy for T4 lung cancer in a pulmonary-compromised patient.

Ann Transl Med 2015 Dec;3(22):361

1 Department of Thoracic Surgery, 2 Department of Chest Diseases, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Complete resection is the optimal treatment for primary lung cancer. The choice of surgical methods varies depending on tumor size, tumor location, and each patient's respiratory reserve. Currently, lobectomy with lymph node dissection is the gold standard for the surgical management of lung cancer. However, many thoracic surgical candidates also have chronic obstructive pulmonary disease or emphysema and thus present with minimal lung reserve. In the past few years, more reports have been published on the outcomes of patients who underwent anatomic segmentectomy for lung cancer. Herein we report the surgical outcomes of a patient with limited respiratory reserve, who underwent double segmentectomy.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.12.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701516PMC
December 2015

Reply.

Ann Thorac Surg 2016 Feb;101(2):829-30

Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

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http://dx.doi.org/10.1016/j.athoracsur.2015.09.060DOI Listing
February 2016

Is Video-Assisted Thoracoscopic Surgery Adequate in Treatment of Pulmonary Hydatidosis?

Ann Thorac Surg 2015 Jul 21;100(1):258-62. Epub 2015 May 21.

Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

Background: Surgical management of pulmonary hydatid cyst disease has been well established. However, there are still limited data on the role of video-assisted thoracoscopic surgery in treatment of this disease. The aim of this study is to identify the advantages and disadvantages of minimally invasive surgery and compare the outcomes with patients undergoing thoracotomy in this parasitic disease.

Methods: The medical records of 77 patients (53 male, 24 female) undergoing surgery for pulmonary hydatid cyst disease between January 2011 and January 2014 were reviewed. Removal of the hydatid cyst was completed using video-assisted thoracoscopic surgery in 39% (n = 30) of the patients, whereas open thoracotomy was used in 61% (n = 47). Conversion rate was 21%. Statistical analysis was used to assess differences in drainage amount, time to drain removal, length of surgery, length of hospital stay, and pain scores. Probability values of less than 0.05 were considered significant.

Results: The drainage amount, time to drain removal, length of surgery, duration of narcotic analgesics usage, and visual analog scale scores in the thoracotomy group were significantly longer than those of the thoracoscopy group. Postoperative complications occurred in 4.3% of thoracotomy and in 13.3% of thoracoscopy patients. There was no mortality in either group. During the follow-up period, no recurrence was detected.

Conclusions: Video-assisted thoracoscopy for surgery of pulmonary hydatid cyst disease is superior to open thoracotomy causing less postoperative pain, a better cosmetic result, a shorter surgical time, a lower drainage volume, and a shorter time to drain removal in a selected group of patients. The fear of recurrence because of incomplete isolation of the cyst during removal was not a concern regarding our technique.
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http://dx.doi.org/10.1016/j.athoracsur.2015.03.011DOI Listing
July 2015

Chondrosarcoma of the anterior chest wall: surgical resection and reconstruction with titanium mesh.

J Thorac Dis 2014 Oct;6(10):E230-3

Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

Primary malignant tumors of the chest wall are uncommon. Chondrosarcoma is the most common malignancy of the sternum. The current therapy for chondrosarcoma requires adequate surgical excision. A 52-year-old man presented with a lower-sternal mass. Thorax computed tomography (CT) revealed a well-lineated, hypodense and round mass, which highly suggested the sarcoma of the chest wall. The tumor involved 1/3 distal part of the corpus sterni. Incisional biopsy of the mass was reported as chondrosarcoma. In order to obtain disease-free surgical margins, 1/3 distal part of the sternum with costochondral junctions was resected and reconstruction of anterior chest wall was performed with titanium mesh. The postoperative course was uneventful. The titanium mesh provided the essential rigidity and minimal elasticity over the surgical wound. Our findings show that this technique is adequate even for reconstructing extensive defects of the anterior chest wall.
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http://dx.doi.org/10.3978/j.issn.2072-1439.2014.09.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215132PMC
October 2014

Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy.

Interact Cardiovasc Thorac Surg 2014 Oct 3;19(4):650-5. Epub 2014 Jul 3.

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey.

Objectives: Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies. Thus, chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak. This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy.

Methods: Seventy-two consecutive patients undergoing straightforward lobectomy were randomized into two groups. Patients with conditions affecting postoperative drainage and with persisting air leaks beyond the third postoperative day were excluded. Drains were removed if the pleural fluid to blood protein ratio (PrRPl/B) was ≤0.5, regardless of its daily draining amount in the study arm (Group S; n = 38), and patients in the control arm (Group C; n = 34) had their tubes removed if daily drainage was ≤250 ml regardless of its protein content. Patients were discharged home immediately or the following morning after removal of the last drain. All cases were followed up regarding the development of symptomatic pleural effusions and hospital readmissions for a redrainage procedure.

Results: Demographic and clinical characteristics as well as the pattern of decrease in PrRPl/B were the same between groups. The mean PrRPl/B was 0.65 and 0.67 (95% CI = 0.60-0.69 and 0.62-0.72) on the first postoperative day, and it remarkably dropped down to 0.39 and 0.33 (95% CI = 0.33-0.45 and 0.27-0.39) on the second day in Groups S and C, respectively, and remained below 0.5 on the third day (repeated-measures of ANOVA design, post hoc 'within-group' comparison of the first postoperative day versus second and third days; P < 0.002). Eleven of 38 (29%) and 16 of 27 (59%) patients' chest tubes were, respectively, removed on the first and second postoperative days in Group S, but only two of 34 (6%) and ten of 32 (31%) patients, respectively, had their chest tubes removed in Group C (two-tailed Fisher's exact test, P = 0.02 and 0.005 for the first and the second postoperative days, respectively). On the third postoperative day, daily drainage remained ≥250 ml in 22 (65%) patients, among whom, 17 (77%) would have their chest tubes removed on the PrRPl/B value in Group C. However, drains could not be removed due to the high protein content of draining fluid despite the acceptable volume of daily drainage in only three (27%) of 11 cases in Group S (McNemar's paired proportions test, P = 0.009). The mean chest tube removal time (2.1 ± 0.9 vs 2.9 ± 1.0 days; P < 0.001) and the median hospital stay [3 days (IQR: 1-3) vs 4 days (IQR: 2-4), P < 0.003] were significantly shorter in Group S. None of the patients required a redrainage procedure due to a persistent and symptomatic pleural effusion.

Conclusions: Regardless of the daily drainage, chest tubes can safely be removed earlier than anticipated in most patients after lobectomy if the protein content of the draining fluid is low.
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http://dx.doi.org/10.1093/icvts/ivu207DOI Listing
October 2014

One-port videothoracoscopic surgical intervention.

Surg Laparosc Endosc Percutan Tech 2015 Feb;25(1):40-2

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Educational and Research Hospital, Istanbul, Turkey.

Background: One-port video-assisted thoracic surgery (VATS) has recently been proposed as an alternative to conventional 3-port VATS. To reduce pain, chest wall paresthesia, and hospital stay, lesser ports are the current direction.

Materials And Methods: From 2007 to 2010, 98 patients underwent 1-port VATS procedure. The charts were retrospectively evaluated. A 2.5 cm long incision was made at the sixth intercostal space in the median axillary line. A single flexible port was used. Both the camera and the endoinstruments were introduced through the port. Patient characteristics, visual analog score, and postoperative paresthesia scores were evaluated.

Results: The study enrolled 38 women and 60 men with the mean age of 49.1±1.5 years (range, 19 to 75 y). Thirty-one patients (28.6%) were diagnosed with malignant pleural effusion. Perioperative pleurodesis with talc was performed in 81% of them. One-port VATS approach was used for pleura biopsies in 77 (78.6%), wedge resection in 4 (3.8%), pleurectomy in 13 (12.4%), and biopsy with talc chemical pleurodesis in 4 (3.8%) instances. The mean operation time was 24.4 minutes (range, 15 to 50 min). No major cardiorespiratory or surgical complications were noted. The median observation time was 60 months (range, 36±81 mo). Among benign pathology patients, 56 (82.3%) of them did not complain about any pain; however, 12 patients had prolonged discomfort (2 pinprick, 6 numbness, and 4 pruritus).

Conclusions: One-port VATS in selected patients are feasible and seems to be safe in thoracic surgical interventions instead of conventional 3 ports that was presented in this series.
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http://dx.doi.org/10.1097/SLE.0000000000000013DOI Listing
February 2015