Alper Ucak

Gulhane Military Medical Academy, Engüri, Ankara, Turkey

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Publications (57)73.26 Total impact

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  • The Journal of thoracic and cardiovascular surgery 05/2014; 147(5):1723. · 3.41 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 04/2014; 147(4):1434-5. · 3.41 Impact Factor
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    ABSTRACT: Background: Saphenous vein mapping provides accurate identification of the graft diameter, location of the harvest side, and quality of graft and also led to a selective leg skin incision. In this article, we aimed to compare patients who underwent coronary artery bypass graft (CABG) surgery with or without vein mapping.Methods: Patients who underwent CABG surgery with saphenous vein grafts (SVG) between January 2005 and January 2010 in our service were analyzed retrospectively. One hundred seventy-eight 178 SVGs were harvested with classical methods (Group A), and 136 SVGs were harvested after Doppler ultrasonography (USG) mapping (Group B).Results: In Group A, 6.7% of patients needed additional incisions for graft harvesting than planned before CABG surgery due to unsuitable vein grafts. In Group B, SVGs were harvested from left lower extremity in 16 patients, and the saphenous vein was not suitable for grafting in 1 patient due to Doppler examination. In the postoperative period, complications at the incision site were reduced in Group B.Conclusion: Preoperative vein mapping for harvesting SVGs is an effective method in reducing wound site complications, hospital stay, and hospital costs and in increasing patient comfort and satisfaction.
    Heart Surgery Forum 10/2013; 16(5):E248-51. · 0.56 Impact Factor
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    ABSTRACT: Background: Saphenous vein mapping provides accurate identification of the graft diameter, location of the harvest side, and quality of graft and also led to a selective leg skin incision. In this article, we aimed to compare patients who underwent coronary artery bypass graft (CABG) surgery with or without vein mapping.Methods: Patients who underwent CABG surgery with saphenous vein grafts (SVG) between January 2005 and January 2010 in our service were analyzed retrospectively. One hundred seventy-eight 178 SVGs were harvested with classical methods (Group A), and 136 SVGs were harvested after Doppler ultrasonography (USG) mapping (Group B).Results: In Group A, 6.7% of patients needed additional incisions for graft harvesting than planned before CABG surgery due to unsuitable vein grafts. In Group B, SVGs were harvested from left lower extremity in 16 patients, and the saphenous vein was not suitable for grafting in 1 patient due to Doppler examination. In the postoperative period, complications at the incision site were reduced in Group B.Conclusion: Preoperative vein mapping for harvesting SVGs is an effective method in reducing wound site complications, hospital stay, and hospital costs and in increasing patient comfort and satisfaction.
    Heart Surgery Forum 10/2013; 16(5):E248-51. · 0.56 Impact Factor
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    ABSTRACT: OBJECTIVES Coarctation accompanied by cardiac lesions is a complex clinical situation due to the presence of two different pathologies that necessitate surgical treatment. An individual strategy, according to the severity of the disease, is important to reduce perioperative mortality and morbidity.METHODS We report here on 25 patients with coarctation accompanied by cardiac lesions who were treated by various surgical approaches. Coarctation and associated disease were treated in 14 patients in a single stage by an ascending-to-descending bypass (n = 11) or by a hybrid procedure (n = 3). The remaining 11 patients underwent a two-stage operation for their treatment. Six of these 11 patients who had coronary artery disease or signs of congestive heart failure were first operated for their cardiac disease, whereas in the remaining five patients, who did not have any congestive signs, coarctation repair was performed first.RESULTSAll the patients were male, between the ages of 20 and 24 years, except for one 45-year-old woman. The mean cross-clamp times, cardiopulmonary bypass times and operation times were 52 ± 14.5, 102.3 ± 28.5 and 174 ± 24.8 min in the extra-anatomical bypass group; 29.8 ± 11.7, 55.5 ± 17.6 and 116 ± 22 min in the two-stage groups and 49 ± 19.8, 63 ± 18.7 and 159 ± 21.3 min in the hybrid patients, respectively. One patient who underwent extra-anatomical bypass died on the 14th postoperative day. There were no events during the follow-up period for the other patients. Also, there were no gradients between the extremities and no graft-related complications.CONCLUSIONS As a consequence of the progress in the development of endovascular techniques, hybrid treatment is becoming a more popular option for the treatment of coarctation accompanied by cardiac diseases. Two-stage procedures and extra-anatomical bypass might be alternative techniques if endovascular procedures are contraindicated or failing.
    Interactive Cardiovascular and Thoracic Surgery 06/2013; · 1.11 Impact Factor
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    ABSTRACT: Background: Anomalous pulmonary venous drainage commonly accompanies sinus venosus atrial septal defects (SVASDs). Many techniques have been reported for avoiding postoperative complications, such as narrowing of the superior vena cava (SVC) or the pulmonary system, and arrhythmia. We perform a single V-Y pericardial patch plasty repair technique for SVASDs. The purpose of this study is to report on the long-term results of this surgical technique.Methods: We retrospectively analyzed patients who had a diagnosis of ASD and who underwent their operations between 2000 and 2010 at the Gulhane Military Medical Academy Haydarpasa Training Hospital. Thirty-nine of the patients had an anomalous pulmonary return, and the single pericardial patch technique had been performed in 32 of these patients.Results: The mean (±SD) postoperative extubation time was 5 ± 1.6 hours. The mean drainage volume was 384 ± 137 mL. All patients were discharged from the hospital at a mean of 4.6 ± 1.1 days after their operation and were prescribed anticoagulants for 3 months. No perioperative or late-term mortality was observed. Patients were followed up for 6 months to 2 years. There were no residual shunts and no stenosis-related findings in the pulmonary venous system or the SVC.Conclusion: Use of the single pericardial patch plasty technique might lower complication rates in patients with SVASD, especially those who have not completed their growth.
    Heart Surgery Forum 04/2013; 16(2):E85-8. · 0.56 Impact Factor
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    ABSTRACT: Atherosclerosis might affect all arterial segments of the vascular system, thus peripheral arterial disease (PAD) accompanying coronary artery disease (CAD) is not uncommon. In addition to this coexistence, abdominal aortic aneurysm (AAA) is frequently associated with CAD. Although treatment strategies of CAD and PAD or CAD and AAA has been reported previously, treatment of these three pathologies has not been reported. The management of a therapeutic strategy is important for avoiding perioperative mortality and morbidity in CAD associated with AAA and PAD. We are reporting our simultaneous treatment strategy of three pathologies with endovascular AAA repair, stent implantation into the superficial femoral artery (SFA) and coronary artery bypass grafting (CABG).
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 03/2013;
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    ABSTRACT: Background In this study, cardiac surgery with minimally invasive reversed C sternotomy was compared with conventional sternotomy in patients undergoing valve replacement or septal defect repair.Methods In this prospective randomized study, 35 patients were assigned into one of two groups for elective cardiac surgery under general anesthesia: Group A (reversed C sternotomy group) and Group B (conventional sternotomy group). Intraoperative variables, intubation time, postoperative drainage volume, pulmonary function tests, sleep quality and quality of life, and requirement for blood transfusion were compared.Results A significant difference between the two groups was found in blood transfusion requirement, extubation time, and drainage volume. Forced expiratory volume in one second and functional vital capacity were significantly lower in Group B than in Group A at postoperative Month 1. Total sleep component score of Pittsburg Sleep Quality Index in Group B patients was significantly worse at postoperative Month 1. Postoperative assessment of quality of life (physical and mental) also showed a significant difference between the two groups.Conclusion These preliminary findings suggest that creating an access point without compromising the integrity of the sternum seems to be an advantageous and appropriate technique for suitable patients undergoing cardiac surgery.
    The Thoracic and Cardiovascular Surgeon 01/2013; · 0.93 Impact Factor
  • International Journal of Cardiology 03/2012; 155:S140. · 6.18 Impact Factor
  • Journal of cardiothoracic and vascular anesthesia 02/2012; · 1.06 Impact Factor
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    ABSTRACT: After traditional treatment of acute type I aortic dissection, the possible persistence of residual false lumen in the untouched distal aorta can increase the risk of death.This case report presents an example of single-stage complete hybrid repair of acute type I aortic dissection via surgical interposition of an ascending aortic tube-graft and reconstruction of the supra-aortic branches to enable circulatory inflow from the ascending aortic graft, which was followed by endovascular stenting of the arch and of the descending and thoracic aortic segments. This procedure was performed with partial sternotomy and without circulatory arrest, to improve early and late outcomes.Unfortunately, there is no extensive experience with application of the technique described here, and we are contributing a report of only a single case. Nevertheless, we hope that this description of a single-stage complete repair of aortic dissection might lead to further application and eventually to fewer deaths in patients with acute type I aortic dissection. We suggest this approach for use especially in high-risk patients.
    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(3):405-7. · 0.67 Impact Factor
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    ABSTRACT: This study aims to assess the effects of bileaflet preservation versus conventional technique during mitral valve replacement (MVR) on left ventricular functions and end-systolic stress (ESS). Between September 2005 and January 2009, sixty-five patients with mitral regurgitation underwent MVR surgery. In a non-randomized fashion, 34 patients had conventional MVR without chordal/leaflet preservation (group I, c-MVR), and 31 had MVR with total chordal/bileaflet preservation (group II, b-MVR). A prospective clinical and echocardiographic follow-up of patients was performed preoperatively, at 3 months and by 1 year postoperatively. Left ventricular end-systolic/end-diastolic dimensions and volumes decreased by 1 year in the b-MVR group. Left ventricular ESS decreased only in the bileaflet sparing MVR group after surgery, and this decrease was significant by 1 year, compared with the c-MVR group (P = 0.008). Left atrial diameter significantly decreased in both groups. Only one patient died, due to posterior wall rupture after a c-MVR procedure. One patient undergoing a b-MVR procedure needed re-operation because of prosthetic valve endocarditis. Bileaflet preservation during MVR has a beneficial effect on left ventricular function, compared with conventional MVR. Left ventricular ESS improves after bileaflet-sparing MVR and may be an important indicator of myocardial function after mitral valve surgery.
    Acta cardiologica 10/2011; 66(5):627-34. · 0.56 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the analgesic effects of perioperative gabapentin on postoperative acute and chronic pain after coronary artery bypass graft (CABG) surgery with median sternotomy and internal mammary artery harvesting. A double-blind randomized clinical study. A single-academic hospital. Patients with ischemic heart disease who were scheduled to undergo CABG surgery. Forty patients were allocated randomly into 2 groups; the gabapentin group (n = 20) received 1.2 g/d of oral gabapentin before and for 2 days after surgery, and the placebo group (n = 20) received a placebo capsule instead. The primary outcome was to evaluate the effects of gabapentin on acute and chronic pain after surgery. The postoperative evaluation included the assessment of pain at rest and when coughing, intravenous tramadol usage, postoperative morbidities, and side effects of gabapentin. Postoperative analgesia at 6, 12, 18, 24, 48, and 72 hours after extubation and at discharge was evaluated with the visual analog scale. The assessment of postoperative pain at the 1- and 3-month follow-ups was performed using a numeric rating scale. Postoperative pain scores at 1, 2, and 3 days were significantly lower in the gabapentin group when compared with the placebo group (p < 0.05). Pain scores at 1 and 3 months postoperatively were lower in the gabapentin group than in the placebo group (p > 0.05). Consumption of intravenous tramadol given as rescue analgesic within 24 hours after extubation in the gabapentin group was 99.0 ± 53.8 mg versus 149.4 ± 72.5 mg in the placebo group (p < 0.05). There were no differences in the incidence of side effects and time to extubation between the groups. Gabapentin significantly reduced the intensity of pain and tramadol consumption in the early postoperative period after CABG surgery. Pain scores at 1 and 3 months after surgery were low in both groups, with no significant difference between the groups.
    Journal of cardiothoracic and vascular anesthesia 10/2011; 25(5):824-9. · 1.06 Impact Factor
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    ABSTRACT: Introduction La lésion neurologique sévère représente toujours l'une des complications les plus dévastatrices qui peuvent se produire après la réparation chirurgicale des anévrysmes thoraco-abdominaux. Nous avons cherché à étudier le rôle de la rosuvastatine (RSV) contre l'ischémie/reperfusion dans un modèle expérimental d'ischémie médullaire chez le rat. Méthodes Les groupes expérimentaux incluaient un groupe témoin (n = 8), un groupe ischémie/reperfusion (n = 8) par occlusion aortique sans traitement pharmacologique, et un groupe traité au RSV (n = 8) recevant 10 mg/kg/jour par voie orale pour de RSV 3 jours avant l'ischémie médullaire. L'ischémie de la moelle épinière était provoquée par le clampage de l'aorte abdominale entre l'artère rénale gauche et la bifurcation aortique pendant 45 minutes, suivie d'une reperfusion. L'état neurologique était évalué avant l'ischémie médullaire et à 48 heures après l'opération. La moelle épinière était prélevée pour examen histopathologique à l'hématoxyline-éosine et pour analyse biochimique des tissus : taux de malondialdéhyde, de superoxyde dismutase, et de glutathion peroxydase. Résultats Une diminution des taux tissulaires dans la moelle épinière de malondialdéhyde (p = 0,01) et une augmentation de la superoxyde dismutase tissulaire (p = 0,01) et de la glutathion peroxydase (p = 0,09) étaient observées dans le groupe traité par RSV, par rapport au groupe ischémie. Les analyses histopathologiques ont démontré des changements typiques de nécrose ischémique dans le groupe ischémie ; alors que le RSV atténuait la nécrose tissulaire. Les scores totaux de lésions dans le groupe traité RSV étaient significativement diminués, par rapport au groupe ischémie (p < 0,05). Les scores de Tarlov à 48 heures postopératoires étaient plus élevés dans le groupe RSV par rapport au groupe ischémie. Conclusion L'administration de RSV avant une ischémie de la moelle épinière réduit les lésions tissulaires de la moelle épinière en augmentant les taux des enzymes antioxydants, permettant de diminuer l'incidence des troubles neurologiques associés.
    Annales de Chirurgie Vasculaire 07/2011; 25(5):732–742.
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    ABSTRACT: Severe neurological injury still represents one of the most devastating complications occurring after surgical repair of thoracoabdominal aneurysms. We aimed to investigate the role of rosuvastatin (RSV) against ischemia/reperfusion injury in an experimental model of spinal cord ischemia in rats. Experimental groups included control group (n = 8), ischemia/reperfusion group (n = 8) undergoing aortic occlusion without pharmacologic treatment, and RSV-treated group (n = 8) receiving 10 mg/kg/day of RSV orally for 3 days before spinal cord ischemia. Spinal cord ischemia was induced by occlusion of the abdominal aorta between the left renal artery and aortic bifurcation for 45 minutes, followed by reperfusion. Neurological status was assessed before spinal ischemia and at 48 hours postoperatively. Spinal cords were harvested for histopathologic examination with hematoxylin-eosin staining and biochemical analysis for tissue malondialdehyde, superoxide dismutase, and glutathione peroxidase levels. Decreased spinal cord tissue malondialdehyde levels (p = .01) and increased tissue superoxide dismutase (p = .01) and glutathione peroxidase (p = .09) levels were observed in the RSV-treated group, as compared with the ischemia group. Histopathologic analyses demonstrated typical changes of ischemic necrosis in the ischemia group; however, RSV attenuated tissue necrosis. Total injury score in the RSV-treated group was significantly decreased, as compared with the ischemia group (p < .05). The Tarlov scores at 48 hours postoperatively were higher in the RSV group as compared with the ischemia group. RSV administration before spinal cord ischemia reduces spinal cord tissue injury by increasing antioxidant enzyme levels and may reduce the incidence of associated neurological dysfunction.
    Annals of Vascular Surgery 07/2011; 25(5):686-95. · 1.03 Impact Factor
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    ABSTRACT: Hypertrophied anomalous muscle bands (AMBs) in the right ventricular outflow tract (RVOT) may develop in the context of ventricular septal defects (VSDs) and limit persistent pulmonary overflow. In adult patients with a large VSD, persistent AMBs in the RVOT therefore can simulate the role of an externally placed pulmonary artery band. We termed such alterations natural internal bands (NIBs). Our goal was to establish the morphologic nature of the obstructive muscular lesions of the RVOT in patients with a large VSD. Patients who underwent operations for a large VSD in our center, which has a high volume of adult patients with congenital defects, were retrospectively reviewed, and the nature of the NIBs in these patients was documented. All patients underwent transthoracic echocardiography and cardiac catheterization evaluations preoperatively and at postoperative month 3. Histopathologic examination of the AMBs was performed. Of 96 adult patients who underwent operations for a large isolated VSD (mean defect size, 16.9 ± 3.5 mm), 16 patients had a hemodynamically significant NIB. Two different patterns of obstruction were found. Ten of the 16 patients revealed an os infundibulum morphology, and 6 patients revealed systolic bulging of the conal septum. Four of the patients with os infundibulum also had classic tetralogy-type septal malalignment. The mean peak systolic gradient on the RVOT was 56.5 ± 17.2 mm Hg and 53.6 ± 12.3 mm Hg in the patients with os infundibulum and in the patients with systolic bulging of the conal septum, respectively. Surgical repair of the VSD was completed successfully in all patients. Resection of the os infundibulum was performed concomitantly in patients with os infundibulum. At the third postoperative month, the mean peak systolic gradient was 16.8 ± 3.5 mm Hg in patients with os infundibulum and 26 ± 5.9 mm Hg (range, 20-35 mm Hg) in patients with systolic septal bulging. Some mechanisms in adult type VSDs are essential for protecting the pulmonary vasculature. We tried to review these protective mechanisms: hypertrophied AMBs and NIBs.
    Heart Surgery Forum 06/2011; 14(3):E202-6. · 0.56 Impact Factor
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    ABSTRACT: Accessory mitral papillary muscle originating from the interventricular septum is a rare congenital anomaly. A 20-year-old male patient presented with a complaint of exertional dyspnea. On cardiac examination, a grade 3/4 diastolic murmur was heard over the right upper parasternal area, and the apical pulsations were easily palpable over the precordium. Transthoracic echocardiography showed severe aortic regurgitation, dilatation of the left ventricle, and an accessory papillary muscle with its chordae, extending from the interventricular septum to the anterior mitral leaflet in the left ventricular outflow tract (LVOT). There was no mitral regurgitation. Color Doppler imaging showed turbulence set up by the abnormal mitral attachment and an associated mild pressure gradient of 20 mmHg across the LVOT. At surgery for aortic valve replacement, degenerative changes in the aortic leaflets were noted. The accessory papillary muscle was spared to maintain mitral valve functions and an aortic bileaflet mechanical prosthetic valve was implanted. During eight months of follow-up, he was well without any signs of left ventricular systolic dysfunction and mitral regurgitation, with a functioning prosthetic valve.
    Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 12/2010; 38(8):564-7.
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    ABSTRACT: Objectifs Les lésions de la moelle épinière sont une complication majeure des opérations aortiques thoraco-abdominales. Nous avons étudié le rôle neuroprotecteur de l’olmesartan administré à des rats avant l’ischémie contre les lésions d’ischémie-reperfusion (IR). Méthodes Vingt-quatre rats albinos Wistar ont été aléatoirement divisés en trois groupes (n = 8 par groupe) : groupe I (groupe témoin, groupe d’opération feinte), groupe II (groupe IR ayant une occlusion aortique sans traitement pharmacologique), et groupe III (groupe traité par olmesartan recevant 3 mg/kg/j d’olmesartan pendant 14 jours avant l’ischémie). L’ischémie de moelle épinière était induite par un clampage aortique sous-rénal pendant 45 minutes, suivi de la reperfusion. L’état neurologique était évalué en employant le score modifié de Tarlov en préopératoire et 48 heures après l’intervention. Les moelles épinières ont été prélevées pour examen histopathologique avec coloration à l’hématoxyline-éosine et analyse biochimique pour les taux de malondialdéhyde tissulaire, de superoxyde dismutase, et de glutathion peroxydase. Résultats Les rats du groupe d’ischémie avaient des déficits graves à type de paraplégie après la chirurgie, et ils avaient un plus mauvais état neurologique que le groupe d’opération feinte (p < 0,05). Les scores moyens de Tarlov dans les groupes d’ischémie et traité par olmesartan à la 48ème heure étaient respectivement de 1,6 ± 0,4 et 2,2 ± 0,9 (p < 0,05). Les analyses histopathologiques montraient les changements typiques de la nécrose ischémique dans le groupe d’ischémie ; l’olmesartan atténuait la nécrose tissulaire. Des taux médullaires tissulaires diminués de malondialdéhyde (p = 0,047) et des taux augmentés de superoxyde dismutase (p = 0,001) et de glutathion peroxydase (p = 0,009) étaient mesurés dans le groupe traité par olmesartan comparé au groupe d’ischémie. Conclusion L’olmesartan peut protéger la moelle épinière contre les lésions d’IR et réduire l’incidence des troubles neurologiques après occlusion aortique provisoire.
    Annales de Chirurgie Vasculaire 08/2010; 24(6):873-881.
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    ABSTRACT: Spinal cord injury is a major complication of thoracoabdominal aortic operations. We aimed to investigate neuroprotective role of olmesartan administered to rats before ischemia against ischemia-reperfusion (I-R) injury. Twenty-four Wistar albino rats were randomly divided into three groups (n = 8 per group): group I (control group, the sham-operation group), group II (the I-R group undergoing aortic occlusion without pharmacologic treatment), and group III (olmesartan-treated group receiving 3 mg/kg/d olmesartan for 14 days before ischemia). Spinal cord ischemia was induced by infrarenal aortic clamping for 45 minutes, followed by reperfusion. Neurological status was assessed by using modified Tarlov score preoperatively and at 48 hours postoperatively. Spinal cords were harvested for histopathologic examination with hematoxylin-eosin staining and biochemical analysis for tissue malondialdehyde, superoxide dismutase, and glutathione peroxidase levels. The rats in the ischemia group had severe deficits including paraplegia after surgery, and they had a worse neurological status compared with the sham group (p < 0.05). The mean Tarlov scores in the ischemia and olmesartan-treated groups at 48 hours postoperatively were 1.6 +/- 0.4 and 2.2 +/- 0.9, respectively (p < 0.05). Histopathologic analyses demonstrated typical changes of ischemic necrosis in the ischemia group; however, olmesartan attenuated tissue necrosis. Decreased spinal cord tissue malondialdehyde (p = 0.047) and increased tissue superoxide dismutase (p = 0.001) and glutathione peroxidase (p = 0.009) levels were measured in the olmesartan-treated group compared with the ischemia group. Olmesartan may protect the spinal cord from I-R injury and reduce the incidence of associated neurological dysfunction after temporary aortic occlusion.
    Annals of Vascular Surgery 08/2010; 24(6):801-8. · 1.03 Impact Factor

Publication Stats

83 Citations
73.26 Total Impact Points

Institutions

  • 2006–2013
    • Gulhane Military Medical Academy
      • Department of Cardiovascular Surgery
      Engüri, Ankara, Turkey
  • 2008–2012
    • Istanbul Surgery Hospital
      İstanbul, Istanbul, Turkey
  • 2006–2011
    • Haydarpasa Numune Research and Teaching Hospital
      İstanbul, Istanbul, Turkey