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    Association of Age, Sex, and Heart Failure Etiology in Continuous Flow Left Ventricular Assist Device Patients
    (Elsevier Inc., 2023) Balcioglu, O.; Kahraman, Ü.; Ergi, D.G.; Karaca, S.; Engin, C.; Yagdi, T.
    Background: Advanced heart failure studies demonstrate that ischemic factors increase in prevalence with age and are more prominent in men. Ejection fraction (EF) cannot be preserved in these patients, and ischemic cardiomyopathy develops. Non-ischemic factors are more prominent in female heart failure patients, where the EF is preserved. Although an age-associated increase in the rate of heart failure is acknowledged in both sexes, etiologic classifications by sex-based age groups are still lacking. This study examined the etiology of heart failure according to age and sex in ventricular assist device patients. Methods: The patient population included 457 end-stage heart failure patients who received a continuous flow–left ventricular assist device at Ege University Hospital between 2010 and 2017. Age, sex, and cardiomyopathy etiology data were obtained from the hospital database. The Mann-Whitney U test was applied to test the statistical significance among subgroups (95% CI, P <.05 for statistical significance). Results: The prevalence of ischemic cardiomyopathy was significantly lower in male patients aged 18 to 39 years compared to older patients. Conversely, no difference was seen among female patients. The prevalence of dilated cardiomyopathy was higher in male patients who were 18 to 39 years of age compared to older patients, but no difference was present among the female patients. Conclusions: Age and heart failure etiology were demonstrated to be interrelated in men but not in women. The fact that etiologic factors of advanced heart failure in women have a wider range than in men makes the current classification systems insufficient for use in female populations. © 2023 Elsevier Inc.
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    Association of Nutritional Risk Index With Continuous Flow Left Ventricular Assist Device Complications
    (Elsevier Inc., 2023) Balcioglu, O.; Kahraman, Ü.; Ertugay, S.; Engin, C.; Yagdi, T.; Ozbaran, M.
    Background: Studies revealing the relationship between major surgery outcomes and nutritional parameters are increasing daily. Publications demonstrating the relationship between early postoperative success and surgical complications in patients with chronic heart failure and continuous flow left ventricular assist device (cf-LVAD) are limited. The vast majority of patients with advanced chronic heart failure are cachexic, and the reason for this is multifactorial. The aim of this study is to investigate the link between the modified nutritional risk index (NRI) and 6-month survival and complication rates in patients with a cf-LVAD. Methods: This study included statistical analysis of NRI and postoperative parameters of 456 patients with advanced heart failure who had cf-LVAD implantation between 2010 and 2020. Results: The results of this study showed a statistically significant difference between mean NRI values and postoperative parameters such as 6-month survival (P =.001), right ventricular failure (P =.003), infection (P =.001), driveline infection (P =.000), and sepsis (P =.000). Conclusions: This study revealed that 6-month postoperative complications and mortality rates of patients with advanced heart failure in patients with cf-LVAD are closely related to malnutrition status. In these patients, nutrition specialist use would be beneficial both preoperatively and postoperatively to increase surveillance and reduce postoperative complications. © 2023 Elsevier Inc.
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    Our Single Center Experiences with Left Ventricular Assist Device Exchange
    (Elsevier Inc., 2023) Ergi, D.G.; Kahraman, Ü.; Balcıoğlu, Ö.; Yağmur, B.; Yağdı, T.; Özbaran, M.
    Background: Mechanical circulatory support technology continues to evolve to satisfy the needs of advanced heart failure patients. Despite improvements, various problems occur frequently, and surgical exchange of the pump can be a feasible treatment option. Optimal patient selection is key to success in exchange operations. Methods: Using a retrospective observational cohort design, this study aims to evaluate preoperative profiles and clinical courses of patients' undergoing a device exchange operation and identified possible contributors to in-hospital mortality. Currently, 155 left ventricular assist device (LVAD) patients are being followed up in our program. In total, 15 of 155 patients underwent a pump exchange operation. Baseline characteristics, clinical features, and laboratory results were evaluated. The primary outcome was all-cause in-hospital mortality. Results: Of the 15 patients who underwent a pump exchange operation, thrombosis was the primary cause in 12. Five patients experienced in-hospital mortality within 30 days of LVAD exchange. The international normalized ratio (INR) was higher in patients who experienced in-hospital mortality (2.4 [±0.6] vs 1.2 [±0.4], P = .005) than in patients who survived to discharge. In addition, preoperative lactate levels were significantly higher in patients who died within 30 days (2.9 [±2.6] vs 0.9 [±0.4], P = .019). Conclusions: Higher INR and lactate levels could possibly contribute to in-hospital mortality, which underlines the importance of right ventricular function in this patient population. Careful evaluation of the right heart function is of great importance before exchange operations, and preoperative hemodynamic stability is crucial for better postoperative outcomes. © 2023 Elsevier Inc.
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    Retrospective Evaluation of COVID-19 Infection and COVID-19 Vaccines in Heart Transplant Patients
    (Elsevier Inc., 2023) Kahraman, Ü.; Akyol, D.; Çiçek, C.; Balcıoğlu, Ö.; Engin, Ç.; Yağdı, T.; Taşbakan, M.
    Background: Patients who have performed solid organ transplantation in terms of COVID-19 infection are included in the high-risk group. In this study, it was aimed to evaluate the relationship between vaccination and retrospective evaluation of 32 patients who underwent a heart transplant in the clinic and tested positive for SARS-CoV-2 polymerase chain reaction. Methods: In this study, demographic characteristics of the cases, comorbidities, timing of heart transplantation, immunosuppressive treatments, symptoms of COVID-19 infection, lung imaging findings, follow-up (outpatient/inpatient), treatments, 1-month mortality, and vaccination histories against COVID-19 infection were evaluated. The data obtained from the study were analyzed with SPSS version 25.0. Results: The 3 most common symptoms are cough (37.5%), myalgia (28.1%), and fever (21.8%). COVID-19 infection was severe in 6.2% of the patients, moderate in 37.5%, and mild in 56.2%. Hospitalization was required in 5 patients (15.6%, 1 in the intensive care unit), and the other patients were followed up as an outpatient. Severe COVID-19 infection was seen more in 33% of unvaccinated patients; 93.5% were vaccinated. Nineteen patients (68%) were vaccinated before COVID-19 infection. Our patients received the CoronoVac (Sinovac, China) vaccine. Conclusion: COVID-19 infection is more likely to be severe and mortal in patients with heart transplant recipients. It is also crucial to comply with preventive measures other than immunization in this group of patients. This study is the largest series investigating COVID-19 infection in heart transplant recipient patients in our country. © 2023 Elsevier Inc.