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Öğe Chylothorax After Thoracoabdominal Aneurysm Repair: Efficacy of Somatostatin(Elsevier Science Inc, 2011) Oguz, Emrah; Apaydin, Anil Z.; Ayik, Fatih; Balcioglu, Ozlem; Dolapoglu, AhmetChylothorax is a rare but serious complication that presents after thoracoabdominal aortic aneurysm surgery. There are insufficient data to reach a consensus on how to manage it. Some researchers have suggested early reoperation for high output drainage. We present the case of a patient who underwent thoracoabdominal aortic replacement and who subsequently developed postoperative chylothorax. High output (> 1,000 mL per day) chest tube drainage until postoperative day 4 drastically decreased and stopped in a week with the administration of somatostatin and total parenteral nutrition which helped avoid a major re-exploration. Surgery should be reserved as an option only for patients with persistent leaks that do not respond to somatostatin therapy.Öğe Circumferential intimal flap prolapsing into the left ventricle(Texas Heart Inst, 2007) Oguz, Emrah; Apaydin, Anil Z.; Nalbantgil, Sanem; Engin, Cagatay; Ayik, FatihA 54-year-old man with a history of chest pain and dyspnea for 15 days was admitted to our hospital. Diagnostic evaluation, which included transthoracic echocardiography and computed tomographic scanning, revealed an ascending aortic aneurysm (6 cm in diameter), severe aortic valve insufficiency, and possible aortic dissection. The coronary arteries could not be seen, because the catheter could not be placed in their orifices. The patient was taken to the operating room. Intraoperative transesophageal echocardiography revealed an intimal flap in the ascending aorta. The proximal part of the flap was attached to the aortic wall at the level of the coronary Ostia, and its distal part was circumferentially free (Fig. 1). The flap was prolapsing into the left ventricular outflow tract through the aortic valve leaflets at every diastole (Fig. 2A) and moving back to the aortic lumen at systole (Fig. 2B). The patient underwent aortic root replacement by means of the Bentall procedure. During surgical exploration, we saw that the dissection involved the commissures and the orifice of the right coronary ostia and that it ended just proximal to the aortic clamp, which did not necessitate the use of hypothermic circulatory arrest (Fig. 3). The patient was discharged from the hospital 6 days after the operation without complication.Öğe Comparison of Continuous-Flow and Pulsatile-Flow Blood Pumps on Reducing Pulmonary Artery Pressure in Patients With Fixed Pulmonary Hypertension(Wiley, 2013) Ozturk, Pelin; Engin, Aysen Yaprak; Nalbantgil, Sanem; Oguz, Emrah; Ayik, Fatih; Engin, Cagatay; Yagdi, Tahir; Erkul, Sinan; Balcioglu, Ozlem; Ozbaran, MustafaPulmonary hypertension (PH) is considered as a risk factor for morbidity and mortality in patients undergoing heart transplantation. Recently, left ventricular assist device (LVAD) implantation has been increasingly used in reducing pulmonary artery pressure (PAP) in patients with PH unresponsive to medical therapy. Herein, we aimed to compare the efficacy of continuous-flow and pulsatile-flow blood pumps on the improvement of PH in mechanical circulatory support patients. Twenty-seven patients with end-stage heart failure who underwent LVAD implantation surgery were enrolled. Fifteen of them (55.6%) had continuous-flow pump (HeartWare Ventricular Assist System, HeartWare, Inc., Miramar, FL, USA), and 12 of them (44.4%) had pulsatile pump (Berlin Heart EXCOR ventricular assist device, Berlin Heart AG, Berlin, Germany). The efficacy of LVADs on the improvement of PH was compared between continuous-flow and pulsatile pumps by the evaluation of systolic PAP, tricuspid annular plane systolic excursion (TAPSE), right ventricular systolic motion (RVSM), right ventricular ejection fraction (RVEF), and grade of tricuspid insufficiency (TI) for each of the study participants. All of the 15 patients who underwent continuous-flow blood pump implantation surgery (Group 1) were male with a mean age of 46.9 +/- 11.7 years, and in pulsatile-flow blood pump implanted participants (Group 2), the mean age was 40.6 +/- 16.8 years, all of whom were also male (P=0.259). Mean follow-up was 313.7 +/- 241.3 days in Group 1 and 448.7 +/- 120.7 days in Group 2 (P=0.139). In Group 1, mean preoperative and postoperative systolic PAP were measured as 51.7 +/- 12.2mmHg and 22.2 +/- 3.4mmHg, respectively, while those in Group 2 were 54.5 +/- 7.5mmHg and 33.9 +/- 6.4mmHg, respectively. A significantly greater decrease in systolic PAP was noticed in patients with continuous-flow blood pumps (P=0.023); however, no statistically significant difference was found when we considered the change in TAPSE between study groups (P=0.112). A statistical significance in the alteration of RVEF, RVSM, and the grade of TI during study visits was not found between the study groups (P=0.472, P=0.887, and P=0.237, respectively). Although the two studied types of LVADs were found to be effective in reducing PAP in heart transplantation candidates with PH, lesser postoperative systolic PAP values were achieved in patients who underwent continuous-flow pump implantation surgery.Öğe Effect of Pleurotomy on Blood Loss During Coronary Artery Bypass Grafting(Wiley, 2009) Atay, Yuksel; Yagdi, Tahir; Engin, Cagatay; Ayik, Fatih; Oguz, Emrah; Alayunt, Alp; Ozbaran, Mustafa; Durmaz, IsaBackground: We conducted a retrospective study to compare two different techniques of internal mammarian artery (IMA) preparation concerning pleurotomy upon the effects of blood loss and pulmonary functions. Methods: Between January 1998 and November 2006, 1357 consecutive patients undergoing coronary artery bypass grafting (CABG) using the left IMA, either alone or in combination with saphenous vein graft, were included in this study. The patients were divided into two groups according to the pleural opening: Group I (n = 1046) patients underwent IMA harvesting with pleurotomy and Group 2 (n = 311) patients with intact pleura. Results: During the study, 27 hospital deaths (1.9%) occurred. The amount of postoperative blood loss and blood transfusion requirements were significantly higher in Group 1 than in Group 2 (p = 0.029 and p = 0.0001). The mechanical ventilation stay was significantly higher in Group 1 than in Group 2 (p = 0.0001). The incidence of left pleural effusion and atelectasis was significantly higher in Group 1 than in Group 2 on day 1 and day 3 after operation. Conclusions: These results demonstrate that preserving pleural integrity has beneficial effects on the postoperative blood loss. Postoperative blood loss and transfusion requirements were higher in patients with pleurotomy. Left pleural effusion, atelectasis, and mechanical ventilatory stay were significantly reduced in patients with preserved pleural integrity. (J Card Surg 2009;24:122-126).Öğe Effects of levosimendan on isolated human internal mammary artery and saphenous vein: concurrent use with conventional vasodilators(Wiley, 2016) Ertuna, Elif; Turkseven, Saadet; Amanvermez, Dilsad; Ayik, Fatih; Yagdi, Tahir; Yasa, MukadderGraft spasm is a common problem in coronary artery bypass grafting (CABG). In this study, we aimed to investigate the interaction of levosimendan, a novel inodilator, with vasodilator agents that are clinically used for the treatment of graft spasm and with endogenous vasoconstrictors that are thought to play a role in graft vasospasm, in human internal mammary artery (IMA) and saphenous vein (SV). Isolated human IMA and SV segments derived from patients undergoing CABG were suspended in an organ bath. Responses to cumulative concentrations of noradrenaline (NA), serotonin (5-HT), papaverine, nitroglycerin (NG), and diltiazem were recorded before and after 10(-5) m levosimendan incubation (30 min). In addition, cumulative levosimendan responses were taken in vessels precontracted with NA or 5-HT. 10(-5) m levosimendan reduced NA E-max and sensitivity in IMA and SV, and 5-HT E-max responses in IMA. Moreover, levosimendan caused concentration-dependent relaxation in both grafts. Papaverine E-max or sensitivity was not altered by levosimendan neither in IMA nor in SV. Levosimendan diminished NG sensitivity in IMA and E-max responses in SV and decreased diltiazem E-max responses both in IMA and SV. Our results suggest that levosimendan may be used alone for prevention or treatment of graft spasm in IMA or in combination with papaverine in IMA and SV grafts. However, as concurrent administration with diltiazem or NG causes a reduction in relaxation in vitro, we suggest caution should be exercised when using levosimendan in combination with these agents.Öğe First Successful Experience With The Heartware Assist Device In Child In Turkey(Wiley-Blackwell, 2012) Balcioglu, Ozlem; Erkul, Sinan; Ayik, Fatih; Ulger, Zulal; Karakula, Sultan; Engin, Cagatay; Atay, Yuksel; Yagdi, Tahir; Ozbaran, MustafaÖğe Hydatid Cyst Confined to the Papillary Muscle A Very Rare Cause of Mitral Regurgitation(Texas Heart Inst, 2009) Apaydin, Anil Z.; Oguz, Emrah; Ayik, Fatih; Nalbantgil, Sanem; Ceylan, NaimCardiac involvement of hydatid cysts is rare. Hydatidosis of the valvular apparatus can be treated successfully by the careful application of valvular surgical procedures. To the best of our knowledge, cardiac hydatidosis confined to the anterolateral papillary muscle has not been reported. Herein, we present a case involving a hydatid cyst that was located in a cardiac papillary muscle and that caused mitral regurgitation in a 37-year-old woman. The cyst was removed by papillary muscle incision, and the mitral valve was repaired. The patient experienced an uneventful recovery. (Tex Heart Inst J 2009;36(6):598-600)Öğe Hydatid Cyst Confined to the Papillary Muscle A Very Rare Cause of Mitral Regurgitation(Texas Heart Inst, 2009) Apaydin, Anil Z.; Oguz, Emrah; Ayik, Fatih; Nalbantgil, Sanem; Ceylan, NaimCardiac involvement of hydatid cysts is rare. Hydatidosis of the valvular apparatus can be treated successfully by the careful application of valvular surgical procedures. To the best of our knowledge, cardiac hydatidosis confined to the anterolateral papillary muscle has not been reported. Herein, we present a case involving a hydatid cyst that was located in a cardiac papillary muscle and that caused mitral regurgitation in a 37-year-old woman. The cyst was removed by papillary muscle incision, and the mitral valve was repaired. The patient experienced an uneventful recovery. (Tex Heart Inst J 2009;36(6):598-600)Öğe Immediate Clinical Outcome after Prolonged Periods of Brain Protection: Retrospective Comparison of Hypothermic Circulatory Arrest, Retrograde, and Antegrade Perfusion(Wiley-Blackwell Publishing, Inc, 2009) Apaydin, Anil Z.; Islamoglu, Fatih; Askar, Fatma Z.; Engin, Cagatay; Posacioglu, Hakan; Yagdi, Tahir; Ayik, FatihBackground and Aim: We aimed to compare the immediate clinical outcome after different cerebral perfusion methods, and examine the factors affecting the mortality and neurological outcome. Methods: Between 1993 and 2006, 339 patients underwent proximal aortic operations using a period of cerebral protection. Among these, 161 patients (mean age of 55 +/- 12 years) who required cerebral protection longer than 25 minutes were included in the analysis. Ascending aorta with or without root was replaced in all patients. In addition, total arch replacement was performed in 36 patients. All patients were cooled to rectal temperature of 16 degrees C. Hypothermic circulatory arrest without adjunctive perfusion was used in 48 patients. Retrograde or antegrade cerebral perfusion was added in 94 and 19 patients, respectively. The mean duration of total cerebral protection was 42 +/- 17 minutes. Results: Overall mortality was 15.5% (25/161) and did not differ among the perfusion groups. There was no difference in the incidence of overall neurological events, temporary neurological dysfunction, or major stroke among the groups. Multivariate analysis revealed that transfusion of > 3 units of blood (p < 0.03) was an incremental risk factor for mortality. History of hypertension (p < 0.03), coexisting systemic diseases (p < 0.005), and transfusion of > 3 units of blood (p < 0.04) were predictors of temporary neurological dysfunction. Conclusion: In proximal aortic operations requiring prolonged periods of cerebral protection, the mortality and neurological morbidity are not determined by the type of cerebral protection method only. Factors like hypertension and diabetes may play a role in the development of temporary neurological dysfunction. doi: 10.1111/j.1540-8191.2008.00772.x (J Card Surg 2009; 24: 486-489)Öğe Immediate Clinical Outcome after Prolonged Periods of Brain Protection: Retrospective Comparison of Hypothermic Circulatory Arrest, Retrograde, and Antegrade Perfusion(Wiley-Blackwell Publishing, Inc, 2009) Apaydin, Anil Z.; Islamoglu, Fatih; Askar, Fatma Z.; Engin, Cagatay; Posacioglu, Hakan; Yagdi, Tahir; Ayik, FatihBackground and Aim: We aimed to compare the immediate clinical outcome after different cerebral perfusion methods, and examine the factors affecting the mortality and neurological outcome. Methods: Between 1993 and 2006, 339 patients underwent proximal aortic operations using a period of cerebral protection. Among these, 161 patients (mean age of 55 +/- 12 years) who required cerebral protection longer than 25 minutes were included in the analysis. Ascending aorta with or without root was replaced in all patients. In addition, total arch replacement was performed in 36 patients. All patients were cooled to rectal temperature of 16 degrees C. Hypothermic circulatory arrest without adjunctive perfusion was used in 48 patients. Retrograde or antegrade cerebral perfusion was added in 94 and 19 patients, respectively. The mean duration of total cerebral protection was 42 +/- 17 minutes. Results: Overall mortality was 15.5% (25/161) and did not differ among the perfusion groups. There was no difference in the incidence of overall neurological events, temporary neurological dysfunction, or major stroke among the groups. Multivariate analysis revealed that transfusion of > 3 units of blood (p < 0.03) was an incremental risk factor for mortality. History of hypertension (p < 0.03), coexisting systemic diseases (p < 0.005), and transfusion of > 3 units of blood (p < 0.04) were predictors of temporary neurological dysfunction. Conclusion: In proximal aortic operations requiring prolonged periods of cerebral protection, the mortality and neurological morbidity are not determined by the type of cerebral protection method only. Factors like hypertension and diabetes may play a role in the development of temporary neurological dysfunction. doi: 10.1111/j.1540-8191.2008.00772.x (J Card Surg 2009; 24: 486-489)Öğe Malperfusion Remains the Major Cause of Mortality in Proximal Aortic Operations(Wiley-Blackwell, 2011) Oguz, Emrah; Apaydin, Anil Z.; Islamoglu, Fatih; Ayik, Fatih; Posacioglu, HakanBackground: This study was undertaken to identify the incremental risk factors for early mortality in operations for proximal aortic pathologies. Methods: Between September 2000 and May 2010, 240 consecutive patients underwent replacement of various portions of the proximal aorta. Mean age was 56 +/- 13 years (range 18 to 84) and female/male ratio was 3/7. Operations were performed emergently in 97, urgently in 21, and electively in 122 patients. Thirty-four patients had previous cardiac or aortic operations. Etiology was acute dissection in 102, chronic dissection in 41, degenerative aneurysm in 61, and other factors (endocarditis, pseudoaneurysm, aortitis, etc.) in 36 patients. The ascending aorta was replaced in all patients. In addition, the aortic arch was replaced in 20 and the root was replaced in 106 patients. Results: The in-hospital mortality rate was 10.4% in the overall group (25/240), 21.6% in emergent cases (21/97), 9.5% in urgent cases (2/21), and 1.6% in elective cases (2/122). Morbidity rates were as follows: stroke 2.7%, temporary neurological dysfunction 13.3%, nonoliguric renal failure 3%, dialysis 5.4%, tracheostomy 3.3%, bleeding requiring revision 3.3%. In multivariate analysis, the presence of malperfusion in patients with acute aortic dissection emerged as the incremental risk factor for mortality (p < 0.0001, odds ratio = 10.37). There was no variable associated with stroke. Emergency/urgency of operation did not emerge as incremental risk factors for mortality. Conclusion: Immediate outcomes of elective aortic operations for proximal aortic pathologies are excellent. Complicated acute dissections with malperfusion remain the major cause of early mortality. doi: 10.1111/j.1540-8191.2011.01250.x (J Card Surg 2011; 26: 393-396)Öğe Reoperative Off-Pump Right Subclavian Artery to Right Coronary Artery Bypass Grafting Without Full Sternotomy(Wiley-Blackwell, 2011) Apaydin, Anil Z.; Oguz, Emrah; Posacioglu, Hakan; Calkavur, Tanzer; Ayik, Fatih; Turhan, Soysal; Yavuzgil, Oguz; Ceylan, NaimP>Stenosis or occlusion of a large right coronary artery or its vein grafts in symptomatic patients who underwent previous bypass grafting procedure with patent left-sided grafts is mostly managed by percutaneous interventions. When percutaneous interventions fail, it is a difficult decision to reoperate on a such patient for a single-vessel disease considering the risk of resternotomy. We present our technique which involves small anterior thoracotomy and partial sternotomy. (J Card Surg 2011;26:148-150).Öğe Surgical approaches to the aberrant right subclavian artery(Texas Heart Inst, 2006) Atay, Yuksel; Engin, Cagatay; Posacioglu, Hakan; Ozyurek, Ruhi; Ozcan, Coskun; Yagdi, Tahir; Ayik, Fatih; Alayunt, Emin AlpAberrant subclavian artery (arteria lusoria) is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. The operative approach to correct this condition has been controversial. Herein, we describe surgical approaches to the aberrant right subclavian artery. From 2000 through 2004, 3 children and 1 adult with aberrant right subclavian artery underwent operation. Our surgical approach varied according to the age of the patient. A muscle-sparing right thoracotomy was used in the pediatric patients, and a supraclavicular approach was used in the adult. Patients were treated successfully by division of the aberrant right subclavian artery and translocation to the right common carotid artery, without graft interposition. There was no operative or late morbidity or death. Symptoms were completely relieved in all patients. Although an extrathoracic approach is applicable and reliable for adult patients, we believe that adequate exposure for the described procedure is best accomplished through a right thoracotomy in pediatric patients. This approach enables optimal mobilization of the distal right subclavian artery without leaving a long stump and enables direct anastomosis to the ipsilateral carotid artery.Öğe Surgical Repair of Middle Aortic Syndrome in a Three-Year-Old Patient(Wiley, 2011) Ayik, Fatih; Engin, Cagatay; Ertugay, Serkan; Atay, YukselMiddle aortic syndrome is a rare variation of aortic coarctation that is localized to the distal thoracic and abdominal aorta, and can involve the visceral and renal arteries. Irreversible organ damage and end-stage congestive heart failure may be the possible harmful complications of this disease in untreated patients. We report a three-year-old patient with diffuse thoracic and abdominal aorta hypoplasia treated with a thoracic to abdominal aortic bypass graft. (J Card Surg 2011;26:659-662)Öğe An unusual approach for ascending aorta graft infection: pectoral muscle flap-wrapping via intercostal space(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2016) Akyuz, Muhammet; Isik, Onur; Ayik, Fatih; Atay, Yuksel
