[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Coronary occlusion techniques during OPCAB may lead to an endothelial damage to the target vessel. The adverse effects of these techniques are well-known, and researches have been trying to find out new materials to occlude the coronary artery without an endothelial damage. In the present study, we investigate to the endothelial damage in the rat aorta which is occluded by Poloxamer 407 gel. METHODS: Forty-five rats were randomized in three groups: (1) segment of the aorta was occluded with Poloxamer 407 gel in P 407 group; (2) segment of the aorta was occluded with microvascular clamp in MV clamp group; and (3) no onclusion was available in the Control group. The rats were sacrificed of observation, and a 15mm segment of the aorta was obtained as a specimen. Integrity of the endothelial lining was observed with a scanning electron microscopy. RESULTS: Scanning electron microscopy revealed a statistically significant difference among the 3 groups (p<0,001) using the SPSS 13.0 test. No difference was found between the Control group and the P 407 group (p=0,059). The differences between MV clamp--Control group (p<0,001) and MV clamp--P 407 group were statistically significant (p<0,002). CONCLUSIONS: We suggest that Poloxamer 407 gel occlusion may be a safer and more effective method compared to the microvascular clamp occlusion.
Journal of Cardiothoracic Surgery 01/2013; 8(1):16. · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Leiomyosarcomas rarely arise from primary veins, especially the great saphenous vein. The present report is about a 67 years old female patient who was having a mass medially above her knee, having mild pain and tenderness while walking, for nearly 4 months. The mass was diagnosed as trombosed varicose vein at an outher center and was referred for the operation. After further investigations done at our instution patient was operated successfully. The pathological examination revealed leiomyosarcoma of the great saphenous vein with free margins. The patient did not have any evidence of distal metastasis at the preoperative period and also revealed no evidence of any recurrence during the 24 months of follow up period.
Turkish Journal of Vascular Surgery. 10/2012; 21(3):294-296.
[Show abstract][Hide abstract] ABSTRACT: Background: In this study, we aimed to investigate the preoperative and operative risk factors in patients undergoing valve replacement for the second time, including the types of valves and surgical methods used.
Methods: Between January 1994 and December 2009, a total of 2089 valve replacements were performed in our clinic, and 182 (112 females, 70 males) of these operations (8.7%) were repeat valve surgeries.
Results: The mean age for repeat surgery was 49.2±27.4 years while the mean time elapsed between the first and second surgeries was 11.8±5.7 years. The follow-up period after repeat surgery was 2.6±1.3 years. Bioprosthesis valves were removed from a total of 142 patients (78%), and mechanical valves were removed from 40 patients (22%). In total, 221 valves were replaced. The total number of valves implanted was 219, and valve repair alone was performed on three patients. Of the valves implanted in repeat surgery, 197 (90%) were mechanical valves. The preoperative echocardiography findings revealed that the major problem (84%) observed was valve dysfunction, followed by infection. Fifteen patients (8.2%) who underwent repeat surgery died during the operation or within the first month afterwards.
Conclusion: Repeat heart valve surgery may be performed using the standard surgical procedures with acceptable mortality. Factors increasing the probability of repeat surgery include emergency interventions and infections; however, pulmonary hypertension is not a factor that increases the probability of repeat valve replacement surgery.
Turkish Journal of Thoracic and Cardiovascular Surgery 07/2012; 20(3):497-502. · 0.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to compare the effects of ticlopidine and clopidogrel on the development of neointimal hyperplasia after experimental arterial injury.
This experimental, prospective, randomized controlled study was performed on twenty-seven rabbits, which were divided into three groups, each of which contained nine subjects. Following the development of a balloon catheter injury in the iliac artery, no drugs were administered to Group 1 (control). Group 2 was given ticlopidine, while Group 3 was given clopidogrel. At the end of the 21-day experimental period, arterial sections were evaluated histomorphologically and immunohistochemically with staining using antibodies against platelet derived growth factor beta and basic fibroblast growth factor. Statistical analyses were performed using Chi-Square, Mann Whitney U and one-way ANOVA tests.
At the end of study period, ticlopidine and clopidogrel strongly reduced the development of intimal hyperplasia after arterial injury (54.1%, p<0.001, 53.2%, p<0.001, respectively). No significant difference was observed in terms of intimal and medial areas between the drug-treated groups. Expressions of the basic fibroblast growth factor and platelet derived growth factor beta were significantly lower in the intima of drug treated groups with respect to the control group (p<0.05).
The results of our study suggest that ticlopidine and clopidogrel, which are widely used in antiplatelet treatment in clinics, can similarly prevent the development of intimal hyperplasia after experimental arterial injury.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 02/2010; 10(1):11-6. · 0.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Metabolic syndrome is a well-known cardiovascular risk factor closely related to increased insulin resistance. This study assessed the effects of metabolic syndrome on early post-operative mortality and morbidity in 100 coronary artery bypass graft (CABG) patients: 50 patients with and 50 without metabolic syndrome. A total of 17 patients were excluded from the analysis as they did not attend follow-up, leaving 51 males (61.4%) and 32 (38.6%) females of mean +/- SD age 60.02 +/- 9.76 years for analysis. Diabetes, hypertension and a high body mass index were significantly more common in patients with metabolic syndrome. A statistically significant relationship was found between metabolic syndrome and surgical wound infection. Non-significant positive correlations were found between metabolic syndrome and post-operative atrial fibrillation, surgical revision due to haemorrhage, ventricular tachycardia and ventricular fibrillation, and prolonged intubation. In conclusion, metabolic syndrome did not affect mortality, but did increase the risk of post-operative surgical wound infection.
The Journal of international medical research 02/2010; 38(1):202-7. · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To examine early results in patients with incision lines closed only along the skin and subcutaneous tissue after removal of the great saphenous vein during coronary artery bypass surgery.
We enrolled 82 patients who underwent elective operations in our clinic between December 2008 and April 2009. The patients had similar demographic characteristics, and the method of incision closure was chosen randomly. Three patients were excluded due to in-hospital mortality. The saphenous incision lines were closed using continuous skin sutures in 41 patients (Group 1) or using continuous subcutaneous sutures followed by continuous skin sutures in 38 patients (Group 2). Patients were followed every day that they were in the hospital, in the first week after being discharged, and at the end of the second month after discharge. The incision lines were evaluated for hematomas, infection, edema, pain and numbness.
During the follow-up performed in-hospital and in the first week after discharge, infection, edema and numbness were observed significantly more often in Group 2 than in Group 1. Hematoma was observed more often in Group 1, and pain was observed more often in Group 2, but neither of these findings reached statistical significance. During the follow-up at the end of the second month after discharge, infection, edema, and numbness were observed significantly more frequently in Group 2.
In patients undergoing saphenous removal using standard procedures, it is sufficient to close the incision line using only skin sutures.
The Open Cardiovascular Medicine Journal 01/2010; 4:293-6.
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation (AF) is still the most frequent rhythm disturbance after coronary artery surgery. Our aim was to evaluate the predictive value of preoperative brain natriuretic peptide (BNP) levels for determining postoperative new-onset AF in patients undergoing isolated first-time coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).
We recruited 144 consecutive patients (51 women and 93 men) who underwent isolated CABG. Preoperative and postoperative data were collected. Preoperative BNP levels were measured the day before surgery.
The median preoperative BNP level was 68 pg/mL. Postoperative AF occurred in 36 (25%) of the patients. Univariate analyses showed that both advanced age and median preoperative BNP levels were associated with postoperative AF (63.9 +/- 8 years versus 57.3 +/- 9.8 years, P < .001; 226 pg/mL versus 65.2 pg/mL, P <.001). Both variables remained independent predictors of postoperative AF after multivariate logistic regression analyses. For advanced age, the odds ratio was 1.074 (95% confidence interval [CI], 1.019-1.131; P = .008); for preoperative BNP level, the odds ratio was 1.004 (95% CI, 1.001-1.006; P = .002). A receiver operating characteristic (ROC) curve demonstrated that preoperative BNP level was a predictor of postoperative AF, with an area under the ROC curve of 0.750. A cutoff value of 135 pg/mL for AF demonstrated a 72.2% sensitivity, a 71.2% specificity, a 45.6% positive predictive value, a 88.5% negative predictive value, and a 71.5% accuracy for predicting postoperative AF.
Elevated preoperative BNP levels and advanced age together are significant predictors for the development of postoperative AF in patients undergoing isolated CABG with CPB.
Heart Surgery Forum 09/2009; 12(4):E211-6. · 0.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the use of prophylactic magnesium sulphate and amiodarone in treating arrhythmias that may occur following coronary bypass grafting operations.
The study population consisted of 192 consecutive patients who were undergoing coronary artery bypass grafting (CABG). Sixty-four patients were given 3 g of magnesium sulphate (MgSO4) [20 ml = 24.32 mEq/L Mg(+2)] in 100 cc of isotonic 0.9% solution over 2 hours intravenously at the following times: 12 hours prior to the operation, immediately following the operation, and on postoperative days 1, 2, and 3 (Group 1). Another group of 64 patients was given a preoperative infusion of amiodarone (1200 mg) on first post-operative day (Group 2). After the operation amiodarone was administered orally at a dose of 600 mg/day. Sixty-four patients in group 3 (control group) had 100 cc. isotonic 0.9% as placebo, during the same time periods.
In the postoperative period, the magnesium values were significantly higher in Group 1 than in Group 2 for all measurements. The use of amiodarone for total arrhythmia was significantly more effective than prophylactic treatment with magnesium sulphate (p = 0.015). There was no difference between the two drugs in preventing supraventricular arrhythmia, although amiodarone significantly delayed the revealing time of atrial fibrillation (p = 0.026). Ventricular arrhythmia, in the form of ventricular extra systole, was more common in the magnesium prophylaxis group. The two groups showed no significant differences in other operative or postoperative measurements. No side effects of the drugs were observed.
Prophylactic use of magnesium sulphate and amiodarone are both effective at preventing arrhythmia that may occur following coronary by-pass operations. Magnesium sulphate should be used in prophylactic treatment since it may decrease arrhythmia at low doses. If arrhythmia should occur despite this treatment, intervention with amiodarone may be preferable.
Journal of Cardiothoracic Surgery 03/2009; 4:8. · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effects of double (n = 60, group 1) versus single (n = 60, group 2) aortic clamping on myocardial function and protection were investigated during coronary artery bypass grafting using a heart-lung pump. In group 1, after opening the cross clamp, proximal anastomosis was completed using side clamps and, in group 2, distal and proximal anastomosis was completed with a single clamp. Cross clamping time in the single-clamp patients (group 2; 77.1 min) was significantly higher than in the double-clamp patients (group 1; 62.9 min). Troponin T was significantly higher in group 2 than in group 1 h and 24 h after surgery. Post-operative left ventricular ejection fraction decreased in both groups, but this was not statistically significant. Post-operative wall motion score index and myocardial performance index increased significantly in both groups compared with the pre-operative level. Overall, the double-clamp technique provided better myocardial protection than the single-clamp technique and neither technique seemed to have a negative impact on the early post-operative global functioning of the left ventricle, however the effect of these techniques on the global functioning of the left ventricle in the late postoperative period needs to be evaluated.
The Journal of international medical research 03/2009; 37(2):341-50. · 0.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Starr-Edwards caged ball valve is one of the oldest cardiac valve prosthesis and was widely used all around the world in the past decades. Despite the long-term results that have been reported there are only a few cases reported that exceed 30 years of durability. Here in, we report a 53-year-old patient with a well-functioning 35-year-old aortic Starr-Edwards caged ball prosthesis.
[Show abstract][Hide abstract] ABSTRACT: A left ventricular posterior-inferior free wall rupture without pseudo aneurysm following inferior myocardial infarction was identified in a 40-year-old male patient. Coronary angiography of the patient demonstrated a total occlusion of the circumflex artery. Repair of the rupture was performed during an elective surgery carried out 15 days after the infarction. We approved to discuss this rarely encountered clinical case with the cases in the literature.
Journal of Cardiac Surgery 10/2008; 24(1):89-91. · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the histological changes occurring after three different treatment modalities for telangiectasias.
Thirty 16-week-old New Zealand white rabbits weighing 2.4-3.1 kg were enrolled in the study. The rabbits were divided into three groups. The group 1 received sclerotherapy, he group 2 received phototherapy, and group 3 received high-power diode laser treatments. All animals were treated on the right dorsal marginal ear vein. Biopsies were taken on days 1, 2, 7, and 30 post-treatment, and histopathogical evaluation was performed.
Clinical and histological thrombosis occurred between days 1 and 7 in all groups. Superficial necrosis, neutrophil infiltration, and recanalization were mostly seen in group 3, whereas thrombosis was prominent in groups 1 and 2.
All of the methods tested appear to have similar mechanisms of action, but had differing clinical and histological results. Phototherapy and laser treatment are non-invasive and do not require an exact, pinpoint technique, in contrast to sclerotherapy. However, sclerotherapy and phototherapy showed better results, especially with regard to recanalization.
Photomedicine and laser surgery 10/2008; 26(5):467-71. · 1.76 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch) 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications.
140 patients undergoing to CABG (Coronary Artery Bypass Graft surgery) were electively enrolled to the study. 1500 ml Ringer solution + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution to start cardiopulmonary by-pass in 70 patients which was defined as group 1. On the other hand, 1500 ml HES 130 - 0.4 + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution in 70 patients in group 2.
INR (International Normalized Ratio), urea levels and blood platelet counts were significantly different between the groups. INR level was higher in group 1, while blood urea and creatinine levels and platelet count were higher in group 2 at the end of the 12th and 24nd hours postoperatively (p = 0.001).In this study, it was shown that the usage of HES 130-0.4 as a prime solution did not have negative effect on postoperative INR level, platelet count, the need for transfusion and the amount of drainage, despite the negative opinions that similar solutions caused coagulation disorders. Another interesting result of the study was that blood platelet count at 24th hour was statistically significantly higher in group 2 (p = 0.001).
HES 130-0.4 solution is an alternative colloidal solution which can be used as the prime solution or as a mixture with the crystalloids in cardio-pulmonary bypass applications.
Journal of Cardiothoracic Surgery 08/2008; 3:45. · 0.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: Tachyarrythmia is one of the most common complication of cardiac surgery. Magnesium, like several other pharmacologic agents, has been used in the prophylaxis of postoperative tachyarrythmias with varying degrees of success. The purpose of this study was to assess the effect of intermittent intravenous magnesium infusion on postoperative tachyarrythmias.
Material and Methods: One hundred twenty patients undergoing elective cardiac operations (coronar artery bypass surgery) were randomized into placebo (n= 60) and magnesium (n= 60) groups. 60 patients in magnesium group were given within 2 hours as 3 gr. magnesium sulfate in 100 cc. isotonic %0,9 solution (MgSO4) [20 ml=24.32 mEq/L Mg2+] iv 12 hours before operation, after bypass, postoperative hour 0 in intensive care, postoperative days 1, 2, 3.
Results: The magnesium group had higher serum magnesium concentrations postoperatively. Patients in the magnesium group had a lower incidence of supraventricular arrythmias (16,6% versus 33,3%; p= 0.036). No differences were demonstrated with respect to ventricular tachyarrythmias. There is significant difference among the groups in subjects, cross aortic clamp (p=0.04), perfusion durations (p= 0.001) and discharge time (p= 0.000). The placebo group had higher postoperative CK-MB and cardiac Troponin T measurements.
Conclusion: Prophylactic use of magnesium sulphate is both effective in preventing arrhythmia that may occur following coronary by-pass operations. If arrhythmia should occur despite this treatment, intervention with other anti-arrytmic drug may be preferred.
[Show abstract][Hide abstract] ABSTRACT: The heart is an endocrine organ that synthesizes 2 different natriuretic peptides: atrial natriuretic peptide and brain natriuretic peptide (BNP). We assessed the relationship between preoperative BNP levels and postoperative complications and outcomes in patients who undergo isolated coronary artery bypass grafting (CABG).
The study consisted of 85 patients undergoing first-time elective CABG. Preoperative BNP levels were significantly correlated with the preoperative ejection fraction (P = .004), the number of vessels grafted (P = .016), cross-clamp time (P = .041), and perfusion time (P = .032). Preoperative BNP levels were higher in patients who developed postoperative new-onset atrial fibrillation (AF) (median BNP, 197 pg/mL versus 65 pg/mL; P = .006), in patients requiring inotropic support (189 pg/mL versus 65 pg/mL; P = .004), and in patients who required an intra-aortic balloon pump (IABP) (325 pg/mL versus 68 pg/mL; P= .021). Analysis of receiver operating characteristic curves demonstrated the preoperative BNP level to be a predictor of new-onset AF, a need for inotropic support, and a requirement for an IABP (areas under the curve, 0.70, 0.70, and 0.79, respectively). BNP cutoff values of 100 pg/mL for AF, 185 pg/mL for inotropic support, and 235 pg/mL for requiring an IABP predicted these postoperative adverse outcomes with 65%, 73%, and 84% accuracy, respectively.
This study suggests that a higher baseline plasma BNP concentration is associated with postoperative new-onset AF, a need for inotropic support, and an IABP requirement in patients who undergo first-time isolated CABG.
Heart Surgery Forum 05/2008; 11(2):E84-9. · 0.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model.
Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted.
Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades.
The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.
Journal of Surgical Research 01/2008; 150(2):261-5. · 2.02 Impact Factor