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Öğe Axillary artery dissection due to blunt shoulder trauma(W B Saunders Co-Elsevier Inc, 2007) Ersel, Murat; Kiyan, Selahattin; Aksay, Ersin; Eygi, Bortecin; Calkavur, TanzerÖğe Can D-dimer testing help emergency department physicians to detect acute aortic dissections?(Aves Yayincilik, 2010) Ersel, Murat; Aksay, Ersin; Kiyan, Selahattin; Bayraktaroglu, Selen; Yuruktumen, Aslihan; Ozsarac, Murat; Calkavur, TanzerObjective: To determine the diagnostic accuracy of D-dimer testing for detection of acute aortic dissection. Methods: This study is a retrospective chart review of patients who had been evaluated with suspicion of acute aortic dissection. All patients' D-dimer levels were determined prior to their further work up in the emergency department. The study was conducted in a tertiary care center between February 2006-August 2008. The D-dimer assay used was the immunoturbidimetric assay, with a normal range up to 0.246 mu g/ml. Statistical analysis was accomplished using Chi-square test, Student's t-test and a receiver-operating characteristics (ROC) curve analysis. Results: Ninety-nine patients were included in the study, 30 patients were diagnosed as having acute aortic dissection and 69 patients were evaluated in non-acute aortic dissection group. In comparison of the two groups, positive D-dimer results were found to be significantly higher in acute aortic dissection group than in non-acute aortic dissection group (p<0.001). Sensitivity of the D-dimer test in detection of acute aortic dissection was found as 96.6% and the negative predictive value of the test was 97.3%. Specificity and positive predictive value of the D-dimer test were 52.2% and 46.8%, respectively. The area under the ROC curve yielded an acceptable certainty for excluding acute aortic dissection on base of negative results (AUC: 0.764; CI 95%: 0.674-0.855; p<0.001). Conclusion: D-dimer testing is helpful for emergency physicians in detection of patients with suspected acute aortic dissection in the emergency department. (Anadolu Kardiyol Derg 2010; 10: 434-9)Öğe Clinical outcomes in "complex" thoracic aortic surgery(Texas Heart Inst, 2007) Apaydin, Anil Z.; Islamoglu, Fatih; Posacioglu, Hakan; Yagdi, Tahir; Atay, Yuksel; Calkavur, Tanzer; Oguz, EmrahAlthough the term "complex aortic surgery" has come into increasing use, it has not been defined. We propose the following definition: replacement or remodeling (not resuspension of commissures) of the aortic root, together with either an intracardiac procedure or a replacement of more than I segment of aorta, all of which require cerebral protection. We retrospectively analyzed data pertaining to 752 patients (mean age, 56 +/- 12 years) who underwent surgery for thoracic aortic disease with aid of cardiopulmonary bypass from October 2000 through December 2005. The replaced segment was the ascending aorta with or without the root in 106 patients, the aortic arch in 15, and the descending aorta in 37. Among these patients, 10 met our proposed criteria and constituted the complex group. In this group, in addition to the aortic root, the entire thoracic aorta (ascending, arch, and descending) was replaced in 4 patients, the total arch in 2, and a partial arch in 1. The remaining 3 underwent valve or coarctation repair. Their outcomes were analyzed as a subgroup within the overall outcome. The in-hospital mortality rate was 12.5% in the overall group (19/152), 4.1% in elective cases (3/73), and 10% in the complex group (1/10). Duration of cardiopulmonary bypass, myocardial ischemia, and total cerebral protection times were significantly longer in the complex group (P < 0.0001). Total cerebral protection time over 40 minutes was the only predictor of neurologic morbidity (P=0.003, odds ratio, 4.7). Procedural complexity, as we defined it, increased neurologic morbidity, but not the mortality rate.Öğe Complement consumption during cardiopulmonary bypass: comparison of Duraflo II heparin-coated and uncoated circuits in fully heparinized patients(Sage Publications Ltd, 1996) Hamulu, Ahmet; Discigil, Berent; Ozbaran, Mustafa; Calkavur, Tanzer; Kara, Erkan; Kokuludag, Ali; Buket, Suat; Bilkay, OnolHeparin attachment to synthetic surfaces is one means of improving the biocompatibility of clinically used cardiopulmonary bypass (CPB) circuits. To assess the effect of heparin-coated circuits on complement consumption during CPB, 40 patients undergoing elective myocardial revascularization were prospectively randomized either to a group in which a completely Duraflo II heparin-coated circuit was used for perfusion (heparin-coated Group, n = 20 patients) or to a control group (n = 20 patients) in which an uncoated, but otherwise standard circuit was used. Full systemic heparinization was induced (activated clotting time, 480 seconds) in all the patients included in the study, regardless of which perfusion circuit was used. The two groups did not differ significantly in terms of bodyweight, aortic crossclamp and extracorporeal circulation times. No patient had difficulty in weaning from bypass and the postoperative period was uneventful in all patients. Concentrations of C3 and C4 were found to be within the 'normal' range in the prebypass period in both groups. There were no significant intergroup differences with regard to C3 and C4 consumption during CPB. We conclude that Duraflo II heparin-coated circuits have no effect in reducing complement consumption during CPB in fully heparinized patients.Öğe Effects of thoracic and hiatal clamping in repair of ruptured abdominal aortic aneurysms(Elsevier Science Inc, 2007) Islamoglu, Fatih; Apaydin, Anil Ziya; Posacioglu, Hakan; Calkavur, Tanzer; Yagdi, Tahir; Atay, YuekselThe purpose of this study was to determine the effects of hiatal and thoracic clamping on postoperative outcome and morbidity and factors affecting mortality and morbidity. The records of 102 patients who had undergone ruptured abdominal aortic aneurysm repair between 1993 and 2005 were evaluated retrospectively. Hiatal clamping and thoracic clamping were performed in 72 patients and 30 patients, respectively. Postoperative complications and survival were evaluated comparatively between the two groups by univariate and multivariate statistical analyses. Overall mortality and hospital mortality rates were 63 ( 61.8%) and 24 ( 23.5%) patients, respectively; and there was no difference between the two groups. Postoperative respiratory complications, gastrointestinal complications, and blood requirement were higher in the thoracic clamping group. Preoperative shock and renal ischemia time (> 30 min) were found to be significant predictors of hospital mortality. Postoperative renal failure was the only independent postoperative predictor of mortality. In the follow-up period, cardiac event was an independent predictor of late mortality. If hospital mortalities were excluded, 5-year and 10-year cumulative survivals were 57.82 +/- 5.85% and 38.16 +/- 6.97%, respectively. Cross-clamp level did not have a significant effect on long-term survival. Although both thoracic and hiatal clamping had no effect on mortality, postoperative respiratory complications, blood requirement, and intestinal ischemia were more pronounced in patients operated with thoracic clamping. Hiatal clamping is preferable for a safe postoperative period.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).
