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    Alterations of Serum Parathormone, Calcium, and Vitamin D Levels in End-Stage Heart Failure Cases Performed with Left Ventricular Assist Device Implantation
    (Galenos Yayincilik, 2018) Ozturk, Pelin; Kirazli, Yesim
    Objective: Determination of the osteoporosis susceptibility in end-stage heart failure (ESHF) cases who underwent left ventricular assist device (LVAD) implantation by examining the alterations of serum parathormone (PTH), calcium, and vitamin D levels. Materials and Methods: Records of 375 patients who underwent continuous-flow LVAD implantation with diagnosis of ESHF in our clinic were retrospectively scanned. Thirty three patients with a minimum three months of follow-up, who had complete data about serum PTH, calcium, 25-hydroxyvitamin-D (25-OH-D), and pro-brain natriuretic peptide (pro-BNP) levels for pre and postoperative periods, as well as those with a bone mineral density (BMD) measurement were included in the study. In cases whose bone mineral density measurements made for lomber and hip region, for parameters that were worked with demographic data, initial and last follow-up serum values were recorded and statistical changes were examined. Furthermore, the effects of implanted LVAD type on the studied parameters were evaluated comparatively. Results: Totally 33 cases, four of female (12.1%), mean age and body mass index were found 52.7+/-12.0 years and 27.3+/-4.3 kg/m(2). Postoperative BMD examinations revealed that 50% of cases osteoporosis and 35.7% of osteopenia. Preoperative serum PTH, calcium, 25-OH-D, osteocalcin, urea, creatinine, glomerular filtration rate, and pro-BNP concentrations were 100.9+/-39.5 pg/mL, 8.9+/-0.8 mg/dL, 26.7+/-17.4 ng/mL, 6.98+/-5.46 ng/mL, 80.2+/-57.9 mg/dL, 1.48+/-0.89 mg/dL, 52.99+/-13.32 mL/minute/1.73 m(2), and 9348.7+/-8176.7 pg/mL; whereas, at the end of the mean follow-up period of 14.2+/-7.7 months, these values were determined as 78.3+/-26.3 pg/mL, 9.2+/-0.5 mg/ dL, 29.8+/-13.8 ng/mL, 7.55+/-3.14 ng/mL, 36.2+/-17.2 mg/dL, 0.98+/-0.26 mg/dL, 59.72+/-1.21 mL/minute/1.73 m(2), and 1838.9+/-1853.2 pg/ mL, respectively (p<0.001, p=0.033, p=0.038, p=0.841, p<0.001, p=0.003, p=0.006, and p<0.001, respectively). There was no statistically significant difference when the cases of two different LVAD type implanted were compared in terms of changes in study parameters. Conclusion: Close control of calcium, 25-OH-D, and PTH serum levels is necessary in patients with ESHF underwent with left ventricular assist device; regarding those who have osteoporosis or osteopenia according to BMD measurements except the daily calcium-rich dietary advice, the regulation of medical treatment should be planned.
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    Anomalous left coronary artery arising from the pulmonary artery repair with pulmonary artery reconstruction
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Ayik, M. Fatih; Oguz, Emrah; Ozturk, Pelin; Atay, Yuksel; Ceylan, Naim; Levent, Erturk; Ozyurek, Ruhi; Alayunt, Emin Alp
    Background: This study aims to report the clinical features, surgical management and outcome of patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) who underwent Takeuchi operation combined with pulmonary artery reconstruction. Methods: We retrospectively reviewed the charts of seven patients (2 females, 5 males, mean age 53.3 +/- 52.1 months; range 6 to 151 months) with the diagnosis of ALCAPA who underwent Takeuchi operation combined with pulmonary artery reconstruction between January 2007 and June 2010 in our clinic. Detailed cardiovascular examination including electrocardiography, chest X-ray, echocardiography. computed tomography coronary angiography and cardiac catheterization were performed preoperatively on all subjects. Demographic characteristics as well as pre- pen- and postoperative data were documented and evaluated. Results: The most common symptom was periodic dyspnea (57.1%), however 28.6% of the patients were asymptomatic. The mean cardiopulmonary bypass duration and mean aortic cross-clamp time were 105.8 +/- 33.0 and 69.4 +/- 35.1 min, respectively. Postoperative durations of mechanical ventilation, Intensive Care Unit stay, and normal ward stay were 15.0 +/- 14.9 hours, 1.8 +/- 0.5 days, and 6.0 +/- 2.7 days, respectively. Malignant arrhythmia was the only complication of surgery which was identified in one patient who died at the 36 hour of post cardiac surgery. Six of seven patients who underwent Takeuchi operation with pulmonary artery reconstruction (85.7%) survived and among all of the surviving patients were symptom-free within a mean follow-up of 11.7 +/- 10.3 months. Conclusion: ALCAPA is a kind of pathology which can be corrected by surgery and an early diagnosis and intervention are of utmost importance for the long-term prognosis.
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    Association between caregivers' coping and children's psychiatric symptoms in the heart transplantation process: A pilot study
    (Wiley, 2021) Kafali, Helin Yilmaz; Kalyoncu, Tugba; Ozbaran, Burcu; Kalyoncu, Emir; Tuncer, Osman Nuri; Ozturk, Pelin; Ozbaran, Mustafa
    Our aim was to investigate whether there is an association between caregivers' coping and children's psychiatric symptoms and quality of life in adolescent heart transplant (HTx) recipients and HTx candidates with left ventricular assist device (LVAD). Fourteen patients were recruited for this pilot study (HTx (n = 8), LVAD (n = 6)). Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (K-SADS) was administered to detect the psychiatric diagnosis of patients. Children's Depression Inventory (CDI), State-Trait Anxiety Inventory, and Pediatric Quality of Life Inventory (PedsQL) were completed by adolescents; Brief Coping Styles Inventory by their caregivers. Six of the participants had an internalizing disorder. Optimistic coping strategy score was significantly higher in the caregivers of adolescents without an internalizing disorder than caregivers of those with an internalizing disorder (U = 2.500, P = .005). Utilizing Spearman's correlation, caregivers' optimistic approach (rho = -0.736, P = .004), and self-confident approach (rho = -0.634, P = .020) had significant negative correlations with children's CDI scores. Moreover, caregivers' optimistic approach score had a significant positive correlation with children's PedsQL score (rho = 0.563, P = .045). According to our preliminary results, it seems that caregivers' optimistic and self-confident coping strategies may be associated with fewer internalizing symptoms and a better quality of life in adolescents in the HTx process. A future multicentered longitudinal study will be planned to assess the effect of caregivers' coping strategies on the psychological adjustment of these children.
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    Association between the low percentage of forced vital capacity and increased mortality after left ventricular assist device implantation
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2020) Ekren, Pervin Korkmaz; Ozturk, Pelin; Ertugay, Serkan; Ozdil, Ali; Nalbantgil, Sanem; Engin, Cagatay; Ozbaran, Mustafa
    Background: This study aims to investigate the effect of low percentage of forced vital capacity measured in the preoperative period on the 28-day mortality in patients undergoing left ventricular assist device implantation. Methods: A total of 131 patients (111 males, 20 females; median age 54 years; range, 47 to 59 years) who underwent left ventricular assist device implantation with HeartWare (TM) between December 2010 and January 2016 were retrospectively analyzed. the patients were divided into two groups according to the results of pulmonary function test as a forced vital capacity percentage of >= 60% (n=113) and <60% (n=18). Both groups were compared in terms of laboratory and clinical characteristics, and postoperative complications. Risk factors for postoperative 28-day mortality were analyzed. Results: Pre- and intraoperative characteristics were similar in both groups, except for left ventricular end-diastolic diameter. the ventilator-free days up to 28 days was shorter (p= 0.046) and the length of intensive care unit stay was longer (p=0.011) in the low percentage of forced vital capacity group. the 28-day mortality rate was also higher (22.2% vs. 9.7%, respectively; p=0.12) in this group. the history of prior cardiac operation (odds ratio: 4.40; 95% confidence interval 1.19-16.20, p=0.026) and tricuspid valve repair at the time of device implantation (odds ratio: 5.30; 95% confidence interval 1.33-21.00, p= 0.018) were found to be independent risk factors for mortality. Multivariate analysis showed that a forced vital capacity of <60% was not associated with mortality (odds ratio: 3.96; 95% confidence interval 0.95-16.43, p=0.058). Conclusion: the length of intensive care unit stay and duration of mechanical ventilation may be longer in patients with a low percentage of forced vital capacity. Although the association between 28- day mortality and low percentage of forced vital capacity is not significant, the risk of 28-day mortality is higher in this group. Therefore, the patients should be assessed carefully before the left ventricular assist device operation.
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    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, Mustafa
    Pulmonary 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.
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    The effect of donor ischemic time on mortality in heart transplanted patients
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Yagdi, Tahir; Ozturk, Pelin; Erkul, Sinan; Oguz, Emrah; Ayik, Mehmet Fatih; Nalbantgil, Sanem; Engin, Cagatay; Ozbaran, Mustafa
    Background: This study aims to evaluate the effects of donor ischemic time on mortality in patients undergoing heart transplantation. Methods: Between March 1998 and September 2012, 172 patients (135 males, 37 females; mean age 39.7 +/- 14.6 years; range 5 to 65 years) who underwent heart transplantation in our clinic were retrospectively reviewed. The patients were divided into two groups according to the graft ischemic time, including being equal or over 200 minutes (group 1) and under 200 minutes (group 2). The possible relationship between donor ischemic time and mortality was investigated during the early, mid, and long-term follow-up period. Results: The mean donor age and follow-up were 29.9 +/- 11.8 years, and 1,295.0 +/- 1,249.1 days, respectively. The mean overall donor ischemic time was 181.7 +/- 61.2 mm with 244.0 +/- 36.9 min in group 1 and 139.0 +/- 30.1 mm in group 2. Although group 1 had higher intraoperative mortality rates (p=0.048), there was no statistical significance in postoperative mortality between two study groups. Each study group was divided into three subgroups with respect of donor age (<= 25 years, 26-39 years, and >= 40 years) and no statistically significant difference was found in overall mortality rates among six study subgroups (p=0.307). Conclusion: Improvements in myocardial protection and perioperative management procedures lead to increased survival rates in patients with heart transplantation. Donor heart preservation, operation procedures and the preoperative status of the recipients are considered more important risk factors on mortality after heart transplantation than donor ischemic time alone.
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    Effect of Testosterone Level on Mortality in Patients With Left Ventricular Assist Device
    (Elsevier Science Inc, 2019) Simsek, Evrim; Kilic, Salih; Kemal, Hatice Soner; Nalbantgil, Sanem; Ozturk, Pelin; Yildirim, Ilgin; Ozbaran, Mustafa
    Background and objectives. Testosterone deficiency is associated with mortality in patients with heart failure; however, its effects on patients undergoing Left Ventricular Assist Device (LVAD) implantation are unclear. We investigated the role of total testosterone (TT) and free testosterone (FT) levels on mortality undergoing LVAD implantation. Methods. Between December 2010 and December 2014, 101 consecutive male patients who underwent LVAD implantation and had plasma testosterone measurement (TT and FT) in the last month before operation were included in the study. Demographics, follow-up, and mortality data were analyzed retrospectively. Results. the mean age of the patients was 51.7 +/- 11 years. TT and FT levels were in the below normal range of 31.6% (n = 32) and 65.3% (n = 66) of the patients, respectively. the mean follow-up time was 355 +/- 268 days, and 32 (31%) patients died during follow-up. Cumulative survival rates were significantly worse in patients with low TT and FT than patients in the normal range (P <.001 and P =.029, respectively). Multivariate analysis after adjustment for clinical variables, age, albumin, C-reactive protein, total cholesterol, chronic kidney disease, diabetes mellitus (DM), and leukocytosis showed that low TT and FT were independently associated with poor survival (HR, 3.680; 95% CI, 1.615-8.385 P =.002 and HR, 3.816; 95% CI, 1.279-11.383, P =.016, respectively). Conclusion. Low TT and FT levels were independent risk factors for mortality in patients with LVAD.
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    Fundus Fluorescein Angiographic Findings in Patients Who Underwent Ventricular Assist Device Implantation
    (Wiley-Blackwell, 2013) Ozturk, Taylan; Nalcaci, Serhad; Ozturk, Pelin; Engin, Cagatay; Yagdi, Tahir; Akkin, Cezmi; Ozbaran, Mustafa
    Disruption of microcirculation in various tissues as a result of deformed blood rheology due to ventricular assist device (VAD) implantation causes novel arteriovenous malformations. Capillary disturbances and related vascular leakage in the retina and choroidea may also be seen in patients supported by VADs. We aimed to evaluate retinal vasculature deteriorations after VAD implantation. The charts of 17 patients who underwent VAD implantation surgery for the treatment of end-stage heart failure were retrospectively reviewed. Eight cases (47.1%) underwent pulsatile pump implantation (Berlin Heart EXCOR, Berlin Heart Mediprodukt GmbH, Berlin, Germany); however, nine cases (52.9%) had continuous-flow pump using centrifugal design (HeartWare, HeartWare Inc., Miramar, FL, USA). Study participants were selected among the patients who had survived with a VAD for at least 6 months, and results of detailed ophthalmologic examinations including optic coherence tomography (OCT) and fundus fluorescein angiography (FA) were documented. All of the 17 patients were male, with a mean age of 48.5 +/- 14.8 years (15-67 years). Detailed ophthalmologic examinations including the evaluation of retinal vascular deteriorations via FA were performed at a mean of 11.8 +/- 3.7 months of follow-up (6-18 months). Mean best-corrected visual acuity and intraocular pressure were found as logMAR 0.02 +/- 0.08 and 14.6 +/- 1.9mmHg, respectively in the study population. Dilated fundoscopy revealed severe focal arteriolar narrowing in two patients (11.8%), and arteriovenous crossing changes in four patients (23.5%); however, no pathological alteration was present in macular OCT scans. In patients with continuous-flow blood pumps, mean arm-retina circulation time (ARCT) and arteriovenous transit time (AVTT) were found to be 16.8 +/- 3.0 and 12.4 +/- 6.2s, respectively; whereas those with pulsatile-flow blood pumps were found to be 17.4 +/- 3.6 and 14.0 +/- 2.1s in patients (P=0.526 and P=0.356, respectively). FA also revealed a tendency for increased frequency of dye leakage from the optic disc in our study population. Except for remarkable delays in both ARCT and AVTT as well as a tendency for increased frequency of dye leakage from the optic disc, ophthalmologic evaluations revealed no other significant pathology or vascular deterioration in the retina that could be attributed to artificial heart systems.
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    Heartware HVAD Application In Heart Failure Treatment, Ege University Experience
    (Wiley-Blackwell, 2012) Erkul, Sinan; Balcioglu, Ozlem; Engin, Yaprak; Daylan, Ahmet; Ozturk, Pelin; Nalbantgil, Sanem; Zoghi, Mehdi; Engin, Cagatay; Askar, Fatma; Yagdi, Tahir; Ozbaran, Mustafa
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    The impact of oral anticoagulation on false lumen patency in acute type A aortic dissections
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2018) Ozturk, Pelin; Apaydin, Anil Ziya; Karakus, Engin; Kilic, Ali Onder; Ozbaran, Mustafa
    Background: In this study, the effect of postoperative oral anticoagulation on the false lumen patency of the distal aorta in patients with acute type A aortic dissection was investigated. Methods: Forty-one patients (32 male, 9 female; mean age 56.8 +/- 13.6 years; range, 30 to 84 years) who were diagnosed with acute type A aortic dissection and underwent surgical treatment in our clinic, and whose entire data of both control computed tomographic assessments and all postoperative follow-up visits could be accessed were enrolled. The patients were divided into two groups according to the type of surgical intervention that was performed. Computed tomography imaging of the patients were scanned and false lumen patency rates were evaluated. Besides oral anticoagulation, preoperative, intraoperative, and postoperative risk factors that may have affected false lumen patency secondary to acute type A aortic dissection were evaluated and statistically analyzed. Results: Twenty-one patients (51.2%) had concomitant hypertension. Thirty five (85.4%) of the patients had the main symptom of angina. Sixteen patients (39%) in Group 1 underwent ascending aortic replacement combined with aortic valve replacement (Bentall procedure); while 25 patients (61%) in Group 2 underwent isolated ascending aortic replacement. Mean follow-up was 43.9 +/- 26.3 (range: 5-120) months. No statistically significant difference was found between the study subgroups in any of the operation parameters except for cardiopulmonary bypass time (p=0.035) and cross-clamp time (p=0.002). Evaluation of the control contrast-enhanced tomographic imaging of the patients showed false lumen patency in the thorax in 34 patients (82.9%) and in the abdominal region in 33 patients (80.5%). When analyzing subgroups according to the type of surgical procedure, or indirectly anticoagulant use, no statistically significant difference was found in false lumen patency prevalence between the thoracic and abdominal groups (p=0.534 and p=0.922). Conclusion: No potential effect of postoperative anticoagulation on false lumen patency was found in cases with acute type A aortic dissection.
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    The importance of autologous blood transfusion in lung transplantation and cardiovascular surgeries
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2021) Akcam, Tevfik Ilker; Ozdil, Ali; Kavurmaci, Onder; Ozturk, Pelin; Basaran, Deniz Can; Calkavur, Ismet Tanzer; Cagirici, Ufuk
    Background: In this study, we aimed to investigate the effect of using autologous blood recovery systems on transfusion-related complications in patients undergoing lung transplantation and cardiovascular surgeries. Methods: Between May 2016 and May 2019, a total of 104 patients (90 males, 14 females; mean age: 59.3 +/- 16.4 years; range, 12 to 89 years) in whom cell-saver and autologous blood recovery systems were used during lung transplantation or cardiovascular surgeries were retrospectively analyzed. The patients were divided into two groups as Group 1 (n=61) consisting of patients who received autologous blood transfusion and as Group 2 (n=43) consisting of patients who did not. Data including demographic and clinical characteristics of the patients, operation data, and postoperative complications were recorded. Results: The total amount of transfused blood/blood product was found to be significantly higher in Group 1 (p=0.018). However, transfusion-related complications were found to be higher in Group 2 (p=0.0261). There was no significant difference in the length of hospital stay between the groups. Conclusion: Autologous blood transfusion may prevent the development of transfusion-related complications by reducing the amount of allogenic transfusion in major surgical procedures. In our study, the autologous blood transfusion was used in critical patients with major bleeding and, therefore, the total amount of transfused blood/blood product was higher in these patients. Nevertheless, lower complication rates in this patient group emphasize the importance of autologous blood transfusion.
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    Left ventricular assist device implantation with left lateral thoracotomy with anastomosis to the descending aorta
    (Oxford Univ Press, 2018) Ozbaran, Mustafa; Yagdi, Tahir; Engin, Cagatay; Nalbantgil, Sanem; Ozturk, Pelin
    OBJECTIVES: Standard implantation of the HeartWare left ventricular assist system is performed using the full sternotomy approach. However, successful implantation of left ventricular assist devices in patients with a previous median sternotomy, especially in high-risk patients, remains challenging. Herein, we compared the HeartWare left ventricular assist system implantation by thoracotomy with anastomosis of the outflow graft to the descending aorta with the standard stemotomy approach. METHODS: Between March 2013 and June 2016, we implanted 118 adult patients with a HeartWare left ventricular assist system, excluding implants with concurrent procedures, paediatric cases and biventricular left ventricular assist device. Of these implants, 30 implants were performed with a lateral thoracotomy with outflow graft anastomosis to the descending aorta. The remaining implants were carried out with the standard median sternotomy with outflow graft anastomosis to the ascending aorta. Propensity matching using the variables age, body mass index, right atrial pressure, blood urea nitrogen, creatinine, cardiomyopathy type and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels resulted in a comparative data set of 30 thoracotomy and 30 sternotomy patients. RESULTS: Within the first 30 days, the incidence of right heart failure (17% vs 10%, thoracotomy vs sternotomy) and bleeding (10% vs 7%, respectively) were similar between the surgical approaches. Thirty-day survival was 93.3% for both groups. Currently, 3 patients in the thoracotomy cohort have been transplanted and 17 remain on support, while in the sternotomy cohort, 1 patient has been transplanted and 21 remain on support. CONCLUSIONS: In our single-centre experience, the lateral thoracotomy with outflow graft anastomosis to the descending aorta had similar early outcomes compared to the standard sternotomy.
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    Outcomes of Various Treatment Strategies for Patients with Continuous-Flow Ventricular Assist Device Thrombosis: A Retrospective Analysis
    (Lippincott Williams & Wilkins, 2016) Ertugay, Serkan; Engin, Cagatay; Daylan, Ahmet; Pektok, Erman; Ozturk, Pelin; Nalbantgil, Sanem; Zoghi, Mehdi; Yagdi, Tahir; Ozbaran, Mustafa
    Pump thrombosis is associated with high morbidity and mortality in patients with a continuous-flow left ventricular assist device. Although it has been defined clearly, the diagnosis and treatment of this complication still remain controversial. Between 2010 and 2014, 163 consecutive patients (mean age: 50.7 +/- 13 years, 84% males, median duration of support: 277 (2-1077) days) were implanted a continuous-flow left ventricular assist device. Prospectively collected data of all patients who had at least one pump thrombosis event have been analyzed, retrospectively. Twenty-one pump thrombosis events were observed in 15 patients (9.2%, 0.137 events/patient-year). Median duration of support at the time of first pump thrombosis event was 259 (8-585) days. Overall mortality was 40% (6/15), and overall procedural success was 71.4% (15/21) in our entire cohort. The cause of mortality was hemorrhagic stroke in those who had medical treatment (n = 5), and sepsis and right ventricular failure in the other who had pump exchange. Pump exchange was performed in five patients, of which four survived. Glycoprotein IIb/IIIa antagonists are not beneficial in medical treatment of pump thrombosis. Medical treatment methods including unfractionated heparin and thrombolytics may completely resolve the thrombus and save some patients from pump exchange. In patients where medical treatment does not result in complete thrombus resolution within a reasonable period, and a donor heart is not available, pump exchange is the ultimate solution. Further studies are needed for optimal dosing of thrombolytics to decrease the rate of side effects.
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    Prospective evaluation of ventricular assist device risk scores' capacity to predict cardiopulmonary exercise parameters
    (Oxford Univ Press, 2020) Gallastegi, Ander Dorken; Ozturk, Pelin; Demir, Emre; Engin, Cagatay; Nalbantgil, Sanem; Yagdi, Tahir; Ozbaran, Mustafa
    OBJECTIVES: Risk scores for left ventricular assist device (LVAD) therapy are known to predict morbidity and adverse events in addition to mortality. This study evaluates the capacity of popular LVAD risk scores to predict cardiopulmonary exercise parameters. METHODS: Adult patients undergoing continuous flow LVAD implantation were prospectively followed. Five risk scores were calculated before implantation: Model for End-stage Liver Disease (MELD), MELD excluding international normalized ratio (MELD-XI), MELD including sodium (MELD-Na), HeartMate2 Risk Score (HMRS) and Destination Therapy Risk Score (DTRS). Cardiopulmonary exercise tests (CPETs) were performed before and after implantation; peak oxygen consumption (vO(2)max), the lowest ventilation to carbon dioxide output ratio (vE/vCO(2)) and exercise time were measured. RESULTS: Ninety-two patients were implanted during the study period; of these, 30 patients completed preimplantation and postimplantation CPETs (CPET cohort). the mean preimplantation and postimplantation CPET dates were 29 +/- 10 days before and 109 +/- 5 days following implantation. CPET parameters significantly improved after implantation (P < 0.05). in multivariate analysis, MELD, MELD-XI, MELD-Na and HMRS independently predicted both preimplantation and postimplantation vE/vCO(2), while MELD-Na and HMRS were also independent predictors of preimplantation and postimplantation vO(2)max, respectively. CONCLUSIONS: Four preimplantation LVAD risk scores (HMRS, MELD, MELD-Na and MELD-XI) independently predict important cardiopulmonary exercise parameters such as vE/vCO(2) and vO(2) max in LVAD therapy. Out of these 4 risk scores, MELD-Na and HMRS appear to be the best predictors of preimplantation and postimplantation CPET parameters, respectively.
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    Retrospective evaluation of emergency department admissions in patients with ventricular assist device
    (Sage Publications Ltd, 2021) Uz, Ilhan; Ozcete, Enver; Ozturk, Pelin
    Background: Ventricular assist devices, improve morbidity and survival in patients with end-stage heart failure. Objectives: To evaluate the major causes of emergency department admissions in patients with ventricular assist device support. Methods: The charts of 200,000 adult patients who presented to our emergency department between January 2016 and January 2018 were reviewed retrospectively. A total of 444 emergency department visits made by 99 patients with ventricular assist device were included in the study. Results: The annual incidence of emergency department admissions of patients with ventricular assist device was 0.1%. The mean age was 55.5 +/- 11.1 years and 85.9% of the study population were men. The most commonly encountered diagnoses were abnormal international normalized ratio or international normalized ratio follow-up (18.2%); heart failure, non-specific chest pain, and chronic obstructive pulmonary disease (15.3%); minor/major bleeding (12.1%); neurological disorders such as ischemic stroke, transient ischemic attack, vertigo, migraine, and syncope (11.2%); non-device related infections (10.8%); ventricular tachycardia/fibrillation episode (8.5%); musculoskeletal disorders (7.2%); and device-related complications such as driveline infection and pump thrombosis (6.3%). Of the patients with bleeding, 31.1% had intracranial bleeding, 31.1% had epistaxis, 24% had gastrointestinal bleeding, 11.1% had hematuria, and 1.8% had gingival hemorrhage. Of the 15 patients who died, 73.3% were diagnosed with intracranial hemorrhage. Conclusion: Even though the mortality rates of patients with ventricular assist device tends to decrease, these patients still have significant morbidity due to the increase in the prevalence of ventricular assist device use. Except for device-related problems, emergency department management of this patient group does not differ much from other patient groups. As early diagnosis of any device-related problems is mandatory for decreasing mortality, emergency department physicians should be familiar with mechanical support systems.
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    Retrospective evaluation of emergency department admissions in patients with ventricular assist device
    (Sage Publications Ltd, 2019) Uz, Ilhan; Ozcete, Enver; Ozturk, Pelin
    Background: Ventricular assist devices, improve morbidity and survival in patients with end-stage heart failure. Objectives: To evaluate the major causes of emergency department admissions in patients with ventricular assist device support. Methods: The charts of 200,000 adult patients who presented to our emergency department between January 2016 and January 2018 were reviewed retrospectively. A total of 444 emergency department visits made by 99 patients with ventricular assist device were included in the study. Results: The annual incidence of emergency department admissions of patients with ventricular assist device was 0.1%. The mean age was 55.5 +/- 11.1 years and 85.9% of the study population were men. The most commonly encountered diagnoses were abnormal international normalized ratio or international normalized ratio follow-up (18.2%); heart failure, non-specific chest pain, and chronic obstructive pulmonary disease (15.3%); minor/major bleeding (12.1%); neurological disorders such as ischemic stroke, transient ischemic attack, vertigo, migraine, and syncope (11.2%); non-device related infections (10.8%); ventricular tachycardia/fibrillation episode (8.5%); musculoskeletal disorders (7.2%); and device-related complications such as driveline infection and pump thrombosis (6.3%). Of the patients with bleeding, 31.1% had intracranial bleeding, 31.1% had epistaxis, 24% had gastrointestinal bleeding, 11.1% had hematuria, and 1.8% had gingival hemorrhage. Of the 15 patients who died, 73.3% were diagnosed with intracranial hemorrhage. Conclusion: Even though the mortality rates of patients with ventricular assist device tends to decrease, these patients still have significant morbidity due to the increase in the prevalence of ventricular assist device use. Except for device-related problems, emergency department management of this patient group does not differ much from other patient groups. As early diagnosis of any device-related problems is mandatory for decreasing mortality, emergency department physicians should be familiar with mechanical support systems.
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    Risk Factors of Gastrointestinal Bleeding After Continuous Flow Left Ventricular Assist Device
    (Lippincott Williams & Wilkins, 2018) Balcioglu, Ozlem; Kemal, Hatice S.; Ertugay, Serkan; Ozturk, Pelin; Engin, Yaprak; Nalbantgil, Sanem; Engin, Cagatay; Yagdi, Tahir; Ozbaran, Mustafa
    This study aimed to compare von Willebrand factor (vWF) levels, ristocetin cofactor levels, platelet counts, aortic valve movements, and right heart failure (RHF) as risk factors of gastrointestinal (GI) bleeding in patients with continuous flow left ventricular assist device (cf-LVAD). In a single centre, 90 patients (mean age 52.0 +/- 10.5 years), of which 59 were male and 31 were female, had cf-LVAD implantation from October 2010 to November 2012. Seventy-six (84.4%) patients had HeartWare (Medtronic, Mounds View, MN) and 14 (15.5%) had Heartmate II (Thoratec, Pleasanton, CA) implanted. vWF level, ristocetin cofactor level, and platelet count were measured before and after implantation to determine the presence of acquired von Willebrand Syndrome; aortic valve movement and postoperative RHF were evaluated to compare the difference in bleeding and nonbleeding patient groups. Fifteen patients (16.6%) suffered GI bleeding after cf-LVAD implantation. A statistically significant decrease was found in vWF and ristocetin cofactor levels from preoperative period to postoperative period in both bleeding and nonbleeding patient groups (p < 0.05). There was no significant difference in bleeding and nonbleeding groups regarding aortic valve movements (p 0.05). Postoperative RHF incidence was significantly high in the bleeding patient group compared with the nonbleeding group (p < 0.05). Therefore, depending on the findings of this study, acquired von Willebrand Syndrome was seen in all cf-LVAD patients, and postoperative RHF was an important risk factor for GI bleeding.
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    Survival Benefit of Implantable-Cardioverter Defibrillator Therapy in Ambulatory Patients With Left Ventricular Assist Device
    (Elsevier Science Inc, 2019) Simsek, Evrim; Nalbantgil, Sanem; Demir, Emre; Kemal, Hatice Soner; Mutlu, Inan; Ozturk, Pelin; Ozbaran, Mustafa
    Background. Analysis of the prognostic effect of concomitant use of left ventricular assist devices (LVADs) and implantable -cardioverter defibrillators (ICDs) is lacking. the aim of this study is to define the survival effects of ICD therapy in ambulatory patients with LVAD. Methods and results. Patients with continuous-flow (cf) LVAD in a single tertiary center from December 2010 to May 2016 were retrospectively analyzed. Over a 6-year period, 257 patients had cf-LVAD implantation, 227 of them survived to discharge after the first month of LVAD implantation and were included in the study. the median follow-up time was 14 months, and 104 (45.8%) patients had 'CD. One hundred and thirty-two (58.1%) patients were still under LVAD support at the end of the study period. Forty (17.6%) patients had heart transplantation, and 55 (24.2%) died. There was no significant difference between groups with ICD and without ICD for baseline characteristics except for higher pulmonary pressures and amiodarone use in the ICD group. Survival analysis showed significant survival benefit of ICD therapy (P =.02). After multivariate analyses including age, sex, left ventricular ejection fraction, and P-blocker usage, the benefit of ICD continued (hazard ratio: 0.54; 95% confidence interval, 0.303-0.975; P =.041). Conclusions. Ventricular arrhythmias (VAs) do not cause acute hemodynamic deterioration in patients with LVAD. However, VAs might be associated with poor prognosis. the present study showed that ICD therapy may improve survival among ambulatory patients with cf-LVAD supported heart failure.
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    Utility of CHA(2)DS(2)-VASc and HAS-BLED Scores as Predictor of Thromboembolism and Bleeding After Left Ventricular Assist Device Implantation
    (Lippincott Williams & Wilkins, 2017) Kemal, Hatice S.; Ertugay, Serkan; Nalbantgil, Sanem; Ozturk, Pelin; Engin, Cagatay; Yagdi, Tahir; Ozbaran, Mustafa
    Ischemic and hemorrhagic events are the common causes of morbidity and mortality after continuous-flow left ventricular assist device (CF-LVAD) implantation. CHA(2)DS(2)-VASc score predicts thromboembolic (TE) event risk and HAS-BLED score predicts bleeding risk in patients on anticoagulant with atrial fibrillation (AF). We aimed to evaluate whether these scoring systems would be predictive of TE and bleeding complications after CF-LVAD implantation. From December 2010 to December 2014, 145 patients who underwent CF-LVAD implantation at a single center were included. Mean age was 50.7 +/- 11.2 years, and 85.5% were male. Baseline CHA(2)DS(2)-VASc and HAS-BLED scores were retrospectively determined for patients with CF-LVADs. After device implantation, all patients were on warfarin (target international normalized ratio 2-3) as well as 300 mg of aspirin daily. Median length of support was 316 days (range 31-1,060), with 22 TE events (15.2%) and 32 bleeding (22.1%) events. The mean CHA(2)DS(2)-VASc score was 2.3 +/- 1.4 and 2.5 +/- 1.2 (p = 0.2) in patients with and without TE event, respectively. The mean HAS-BLED score was 1.8 +/- 0.8 and 1.42 +/- 0.6 (p = 0.004) in patients with and without bleeding, respectively. Baseline high HAS-BLED score was predictive of bleeding events after CF-LVAD implantation, whereas baseline CHA(2)DS(2)-VASc score was not predictive of TE events.
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    Ventricular Support Systems for End Stage Heart Failure Patients: Which patient, When?
    (Elsevier Science Inc, 2013) Engin, Yaprak; Engin, Cagatay; Yagdt, Tahir; Ertugay, Serkan; Nalbantgil, Sanem; Zoghi, Mehdi; Balcioglu, Ozlem; Ozturk, Pelin; Ozbaran, Mustafa