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Öğe Does harvesting of an internal thoracic artery with an ultrasonic scalpel have an effect on sternal perfusion?(Mosby-Elsevier, 2007) Pektok, Erman; Cikirikcioglu, Mustafa; Engin, Cagatay; Daglioz, Gozde; Ozcan, Zehra; Posacioglu, HakanObjectives: Despite many animal and clinical studies to date, there is still debate on the effect of internal thoracic artery harvesting on postoperative sternal perfusion and thus healing. We performed a prospective clinical study to assess the postoperative sternal perfusion in patients who underwent surgical coronary revascularization by means of unilateral internal thoracic artery harvesting and to evaluate the effect of 2 harvesting methods, namely electrocautery and use of an ultrasonic scalpel. Methods: Between November 2004 and March 2005, 30 consecutive patients (25 male patients; age, 58.34 +/- 9.42 years; mean New York Heart Association class, 1.90 +/- 0.76) scheduled for conventional coronary surgery were enrolled in this study. After obtaining informed consent, they were randomized into 2 groups. The left internal thoracic artery was harvested as a pedicle graft in all patients by using the corresponding method. All patients underwent 99mTc-methylene diphosphonate bone scintigraphy preoperatively to evaluate baseline sternal perfusion. Control scintigraphy was performed on postoperative day 7. Results: Sternal perfusion showed a significant increase on postoperative scans compared with that at baseline (1067 +/- 191 counts/pixel vs 919 +/- 102 counts/pixel for the right half, P < .001; 1064 +/- 179 counts/pixel vs 905 +/- 107 counts/pixel for the left half, P < .001). There was no significant difference between the right and left sternal halves postoperatively. The method used for harvest had no significant effect on postoperative sternal perfusion (electrocautery = 1037 +/- 121 counts/pixel vs scalpel = 1097 +/- 109 counts/pixel for the right half, P > .05; electrocautery = 1040 +/- 126 counts/pixel vs scalpel = 1089 +/- 130 counts/pixel for the left half, P > .05). Conclusions: Sternal perfusion increases soon after coronary bypass surgery, probably as a consequence of the healing process, but the source of perfusion for harvest side remains unclear. Harvesting of internal thoracic arteries with an ultrasonic scalpel has no advantageous effects on postoperative sternal perfusion.Öğe The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first EUROMACS Paediatric (Paedi-EUROMACS) report(Oxford Univ Press Inc, 2018) de By, Theo M. M. H.; Schweiger, Martin; Waheed, Hina; Berger, Felix; Huebler, Michael; Ozbarane, Mustafa; Maruszewski, Bohdan; Napoleone, Carlo Pace; Loforte, Antonio; Meyns, Bart; Miera, Oliver; Antretter, Herwig; Krachak, Valeriya; Vanbelleghem, Yves; Meyns, Bart; Nemec, Petr; Netuka, Ivan; Guihaire, Julien; Sandica, Eugen; Miera, Oliver; Stiller, Brigitte; Bodor, Gabor; Amodeo, Antonio; Iacovoni, Attilio; Napoleone, Carlo Pace; Loforte, Antonio; Pya, Yuri; Bogers, Ad; Ramjankhan, Faiz; Maruszewski, Bodhan; Guereta, Luis; Schweiger, Martin; Carrel, Thierry; Sezgin, Atilla; Ozbaran, Mustafa; Pektok, ErmanOBJECTIVES: EUROMACS is a registry of the European Association for Cardio-Thoracic Surgery (EACTS) whose purpose is to gather clinical data related to durable mechanical circulatory support for scientific purposes and to publish annual reports. Because the treatment of children with end-stage heart failure has several significantly different characteristics than the treatment of adults, data and outcomes of interventions are analysed in this dedicated paediatric report. METHODS: Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (<= 19 years of age) performed from 1 January 2000 to 31 December 2017 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events. RESULTS: Twenty-five hospitals contributed 237 registered implants in 210 patients (81 female, 129 male) to the registry. The most frequent diagnosis was any form of cardiomyopathy (71.4%) followed by congenital heart disease (18.6%). Overall mean support time on a device was 11.6 months (+/- 16.5 standard deviation). A total of 173 children (82.4%) survived to transplant, recovery or are ongoing; 37 patients (17.6%) died while on support within the observed follow-up time. At 12 months 38% of patients received transplants, 7% were weaned from their device and 15% died. At 24 months, 51% of patients received transplants, 17% died while on support, 22% were on a device and 9% were explanted due to myocardial recovery. The adverse events rate per 100 patient-months was 0.2 for device malfunction, 0.05 for major bleeding, 0.06 for major infection and 0.03 for neurological events within the first 3 months after implantation. CONCLUSIONS: The first paediatric EUROMACS report reveals a low transplant rate in European countries within the first 2 years of implantation compared to US data. The 1-year survival rate seems to be satisfactory. Device malfunction including pump chamber changes due to thrombosis was the most frequent adverse event.Öğe Koroner baypas hastalarında harmonik skalpel ile lima çıkarılmasının sternum kanlanması ve greft morfolojisi üzerine etkileri(Ege Üniversitesi, 2005) Pektok, Erman; Posacıoğlu, Hakan[Abstarct Not Available]Öğe 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, MustafaPump 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.
