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    Anesthesia for Cardiac Transplantation: Experience From a Single Center
    (Elsevier Science Inc, 2013) Askar, F. Z.; Kocabas, S.; Yagdi, T.; Engin, C.; Ozbaran, M.
    Background. Cardiac transplantation has become the established therapeutic modality in patients with end-stage heart failure. This article presents our institution's clinical experience in the anesthetic management of patients who underwent cardiac transplantation between February 1998 and August 2012. Methods. In our institution, 175 patients (136 males and 39 females) diagnosed as having end-stage heart failure have undergone cardiac transplantation between February 1998 and August 2012. A retrospective review performed on this series of patients sought to analyze elements of perioperative anesthetic care, including preoperative characteristics, general anesthia, and blood product usage. Results. The patients were diagnosed as having either nonischemic cardiomyopathy (n = 128; 73%) or ischemic cardiomyopathy (n = 47; 27%). Seventy-three of them had undergone previous cardiac surgery. Invasive arterial, central venous, and pulmonary arterial pressures were monitored as well as intraoperative transesophageal echocardiography. Etomidate was used as the induction agent in 158/175 patients (average dose, 18.67 +/- 1.91 mg). The average intraoperative fentanyl dose was 898.85 +/- 211.65 mu g. Anesthesia was maintained with either end-tidal 2%-4% sevoflurane (n = 132) or 4%-6% desflurane (n = 43). Dopamine, dobutamine, and epinephrine were used after weaning from cardiopulmonary bypass and continued upon exiting the operating room in 168, 159, and 143 patients, respectively. Inhaled nitric oxide (20-40 ppm) was used in 37 patients (21%). The total amount of perioperative blood, fresh frozen plasma, and thrombocyte suspension transfusions were 2.95 +/- 2.05 (range, 1-15), 1.29 +/- 0.97 (range, 0-6), and 1.23 +/- 2.29 (range; 0-12) units, respectively. On average, patients were extubated 16 hours after arrival in the intensive care unit where they remained to day 6. A total of 67 patients (38%) died during the follow-up; infection and right ventricular failure were the most common causes. Conclusion. Anesthesia for cardiac transplantation requires an appreciation of heart failure pathophysiology, invasive monitoring, and skillful anesthetic and postoperative care.
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    Anesthesia for Ventricular Assist Device Placement in Pediatric Patients: Experience From a Single Center
    (Elsevier Science Inc, 2013) Kocabas, S.; Askar, F. Z.; Yagdi, T.; Engin, C.; Ozbaran, M.
    Background. The use of a ventricular assist device (VAD) as a bridge to heart transplantation in the pediatric population has evolved over the past decades This article presents our institution's clinical experience in the anesthetic management of pediatric patients with end-stage heart failure who underwent implantation of a VAD between June 2009 and August 2012. Methods. Between February 2011 and August 2012, implantation of a VAD was performed in 10 children of mean age 8.6 years. This retrospective review analyzed their perioperative anesthetic care. Results. All patients had end-stage heart failure due to dilated cardiomyopathy. We used invasive arterial and central venous pressure monitoring and intraoperative transesophageal echocardiography in conjunction with intravenous administration of either ketamine (1 mg/kg) and midazolam (n = 3) or thiopental (3-5 mg/kg; n = 7). The mean intraoperative fentanyl dose was 434 +/- 264.27 mu g. Anesthesia was maintained with sevoflurane. Dopamine, dobutamine, and epinephrine were infused in 8, 10, and 5 patients, respectively. Inhaled nitric oxide was administered to all patients. The amounts of perioperative blood, fresh frozen plasma, and thrombocyte suspension transfusions were be 2.3 +/- 0.82 (range, 1-4), 1.6 +/- 0.69 (range, 1-3), and 2.4 +/- 1.42 (range, 0-4) units, respectively. On average, patients were extubated 23 hours after arrival in the intensive care unit and exited there on day 6. Six patients were successfully bridged to heart transplantation, 2 died during the follow-up, and 2 patients remain on VAD support. Conclusion. VAD is increasingly being used as a bridge to heart transplantation in the pediatric population. Anesthesiologists must be vigilant about the pathophysiology of heart failure, the operative procedure, and the implanted device.
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    Anesthesia for Ventricular Assist Device Placement: Experience From a Single Center
    (Elsevier Science Inc, 2013) Kocabas, S.; Askar, F. Z.; Yagdi, T.; Engin, C.; Ozbaran, M.
    Background. Circulatory support with ventricular assist systems has become a treatment alternative for patients with end-stage heart failure owing to the donor shortage. In this report, we have presented our institution's clinical experience in the anesthetic management of ventricular assist device (VAD) implantation. Methods. Between April 2007 and August 2012, VAD implantation was performed in 84 adult patients with end-stage heart failure. The group included 75 male and 9 female patients of overall mean age, 47.6 +/- 13.4 years. Our retrospective review analyzed elements of perioperative anesthetic care, including preoperative characteristics, general anesthetic care, and blood product usage. Results. The indications for VAD implantation were dilated (n = 59; 70%) or ischemic cardiomyopathy (n = 25; 30%). An intra-aortic balloon pump had been placed in 16 patients. We monitored invasive arterial and central venous pressures as well as intraoperative transesophageal echocardiography. Etomidate was used as the induction agent in 79 of 84 patients (average dose, 18.75 +/- 1.40 mg). Intraoperative fentanyl dose was 939.69 +/- 212.44 mu g. Anesthesia was maintained with sevoflurane (n = 55) or desflurane (n = 29). Dopamine, dobutamine, epinephrine, norepinephrine, and levosimendan were used in 74, 79, 60, 14, and 32 patients, respectively. Inhaled nitric oxide was administered to 38 subjects (45%). The amounts of perioperative blood, fresh frozen plasma, and thrombocyte suspension transfusions were 3.96 +/- 2.78, 1.91 +/- 1.21, 1.80 +/- 2.48 u, respectively. On average, patients were extubated 13 hours after arrival in the intensive care unit and discharged therefrom on day 8. Thirty-one patients were successfully bridged to heart transplantation. While 27 patients (32%) died during the follow-up period, 26 are still living on VAD support. Conclusion. Among patients undergoing VAD implantation, the anesthesiologist should become familiar with the device and consider the severity of cardiac and other end-organ dysfunction.
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    Anesthetic Management for Left Ventricular Assist Device Implantation Through Left Thoracotomy: Evaluation of On-Pump Versus Off-Pump
    (Elsevier Science Inc, 2017) Sahutoglu, C.; Turksal, E.; Bilic, U.; Kocabas, S.; Askar, F. Zekiye; Ozturk, P.; Ertugay, S.; Engin, C.; Yagdi, T.; Ozbaran, M.
    Background. Ventricular assist devices (VADs) are alternative approaches to medical treatment in patients with acute or chronic heart failure. The goal of this study was to compare an anesthetic approach in patients undergoing implantation of a VAD with (on pump) or without (off-pump) cardiopulmonary bypass (CPB) through left thoracotomy. Methods. A total of 32 patients were divided into 2 groups: on-pump (group 1) and off pump (group 2). A standard anesthesia protocol was used in all patients. Baseline characteristics of the patients, intraoperative hemodynamic and respiratory variables, anesthetic agents and vasoactive drugs administered, the amount of blood products, extubation, length of hospital stay and intensive care unit stay, and postoperative complications were recorded. Results. Patients' mean age was 54.7 +/- 13.3 years (range, 18-74 years). Eighteen patients underwent surgery with CPB. Demographic data of the patients, preoperative characteristics, intraoperative use of blood products, intraoperative complications, and anesthetic drugs used were similar between groups (P >.05). The duration of surgery (219 +/- 23 vs 273 +/- 56 minutes) and anesthesia (274 +/- 38 vs 323 +/- 57 minutes) were shorter in group 2; there was no difference between the 2 groups in terms of mechanical ventilation time, length of stay in the intensive care unit, and length of hospital stay. There was no decrease in postoperative oxygen parameters and an increase in patient lactate levels with the use of CPB. The use of fresh frozen plasma and platelet suspension in the postoperative period was significantly higher in group 1 (P <.05). The rate of complications and mortality rate were comparable between the 2 groups (P >.05). Conclusions. Our study results show that the use of CPB during VAD implantation via left thoracotomy increases operation time and use of blood products, while causing no change in the rate of complications.
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    Anesthetic Management for Left Ventricular Assist Device Implantation Without Using Cardiopulmonary Bypass: Case Series
    (Elsevier Science Inc, 2015) Karaca, N.; Sahutoglu, C.; Kocabas, S.; Orhaner, B. T.; Askar, F. Z.; Ertugay, S.; Engin, C.; Yagdi, T.; Ozbaran, M.
    Purpose. Ventricular assist devices are an alternative to medical treatment in patients with hemodynamic disturbances related to acute or chronic congestive heart failure. In this case series, we present our anesthesia management for implantation of left ventricular assist device (LVAD) with thoracotomy. Method. Sixteen patients with end-stage heart failure undergoing LVAD implantation via thoracotomy between November 2012 and August 2014 were analyzed prospectively. Preoperative characteristics, intraoperative hemodynamic and respiratory parameters, use of anesthetic and blood products, and durations of mechanical ventilation, hospital, and intensive care stays were recorded. Results. Sixteen patients (mean age, 54.6 +/- 13 years) were investigated. Single-lung ventilation was applied to 2 patients. Cardiopulmonary bypass (CPB) was required in 5 patients. Intraoperative ketamine, midazolam, fentanyl, and rocuronium requirements were 112 +/- 63 mg, 5.5 +/- 3.5 mg, 438 +/- 187 mu g, and 179 +/- 49 mg, respectively. Requirements of fresh donor blood, fresh frozen plasma, and thrombocyte and erythrocyte suspension were 1.19 +/- 1, 1 +/- 0.8, 0.44 +/- 0.5, and 0.25 +/- 0.7 U, respectively. Durations of mechanical ventilation, intensive care unit, and hospital stay were 46 53 hours, 8.2 +/- 6.6 days, and 20.5 +/- 11.6 days, respectively. Twelve patients were discharged from hospital with full recovery and 2 patients died; 2 patients are still receiving treatment in the hospital. Conclusion. A left thoracotomy approach can be used without CPB, because it reduces the incidences of pump complications and blood transfusion. In addition, this case series showed that the implantation of LVAD by thoracotomy can be implemented securely with single-lumen endotracheal tube without single-lung ventilation.
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    Anesthetic Management for Left Ventricular Assist Device Implantation Without Using Cardiopulmonary Bypass: Case Series
    (Elsevier Science Inc, 2015) Karaca, N.; Sahutoglu, C.; Kocabas, S.; Orhaner, B. T.; Askar, F. Z.; Ertugay, S.; Engin, C.; Yagdi, T.; Ozbaran, M.
    Purpose. Ventricular assist devices are an alternative to medical treatment in patients with hemodynamic disturbances related to acute or chronic congestive heart failure. In this case series, we present our anesthesia management for implantation of left ventricular assist device (LVAD) with thoracotomy. Method. Sixteen patients with end-stage heart failure undergoing LVAD implantation via thoracotomy between November 2012 and August 2014 were analyzed prospectively. Preoperative characteristics, intraoperative hemodynamic and respiratory parameters, use of anesthetic and blood products, and durations of mechanical ventilation, hospital, and intensive care stays were recorded. Results. Sixteen patients (mean age, 54.6 +/- 13 years) were investigated. Single-lung ventilation was applied to 2 patients. Cardiopulmonary bypass (CPB) was required in 5 patients. Intraoperative ketamine, midazolam, fentanyl, and rocuronium requirements were 112 +/- 63 mg, 5.5 +/- 3.5 mg, 438 +/- 187 mu g, and 179 +/- 49 mg, respectively. Requirements of fresh donor blood, fresh frozen plasma, and thrombocyte and erythrocyte suspension were 1.19 +/- 1, 1 +/- 0.8, 0.44 +/- 0.5, and 0.25 +/- 0.7 U, respectively. Durations of mechanical ventilation, intensive care unit, and hospital stay were 46 53 hours, 8.2 +/- 6.6 days, and 20.5 +/- 11.6 days, respectively. Twelve patients were discharged from hospital with full recovery and 2 patients died; 2 patients are still receiving treatment in the hospital. Conclusion. A left thoracotomy approach can be used without CPB, because it reduces the incidences of pump complications and blood transfusion. In addition, this case series showed that the implantation of LVAD by thoracotomy can be implemented securely with single-lumen endotracheal tube without single-lung ventilation.
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    Anesthetic Management for Left Ventricular Assist Device Implantation Without Using Cardiopulmonary Bypass: Case Series
    (Elsevier Science Inc, 2015) Karaca, N.; Sahutoglu, C.; Kocabas, S.; Orhaner, B. T.; Askar, F. Z.; Ertugay, S.; Engin, C.; Yagdi, T.; Ozbaran, M.
    Purpose. Ventricular assist devices are an alternative to medical treatment in patients with hemodynamic disturbances related to acute or chronic congestive heart failure. In this case series, we present our anesthesia management for implantation of left ventricular assist device (LVAD) with thoracotomy. Method. Sixteen patients with end-stage heart failure undergoing LVAD implantation via thoracotomy between November 2012 and August 2014 were analyzed prospectively. Preoperative characteristics, intraoperative hemodynamic and respiratory parameters, use of anesthetic and blood products, and durations of mechanical ventilation, hospital, and intensive care stays were recorded. Results. Sixteen patients (mean age, 54.6 +/- 13 years) were investigated. Single-lung ventilation was applied to 2 patients. Cardiopulmonary bypass (CPB) was required in 5 patients. Intraoperative ketamine, midazolam, fentanyl, and rocuronium requirements were 112 +/- 63 mg, 5.5 +/- 3.5 mg, 438 +/- 187 mu g, and 179 +/- 49 mg, respectively. Requirements of fresh donor blood, fresh frozen plasma, and thrombocyte and erythrocyte suspension were 1.19 +/- 1, 1 +/- 0.8, 0.44 +/- 0.5, and 0.25 +/- 0.7 U, respectively. Durations of mechanical ventilation, intensive care unit, and hospital stay were 46 53 hours, 8.2 +/- 6.6 days, and 20.5 +/- 11.6 days, respectively. Twelve patients were discharged from hospital with full recovery and 2 patients died; 2 patients are still receiving treatment in the hospital. Conclusion. A left thoracotomy approach can be used without CPB, because it reduces the incidences of pump complications and blood transfusion. In addition, this case series showed that the implantation of LVAD by thoracotomy can be implemented securely with single-lumen endotracheal tube without single-lung ventilation.
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    The Association Between the Low Percentage of Forced Vital Capacity and Increased Mortality After LVAD Operation
    (Amer Thoracic Soc, 2018) Ekren, P. Korkmaz; Ertugay, S.; Ozturk, P.; Ozdil, A.; Nalbantgil, S.; Engin, C.; Yagdi, T.; Ozbaran, M.
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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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    Associations between PTGS1 gene mutations and aspirin resistance in patients with congenital heart diseases
    (Wiley-Blackwell Publishing, Inc, 2009) Coskun, I.; Atay, Y.; Berdeli, A.; Mecidov, M.; Atay, A.; Ayik, M. F.; Yagdi, T.; Alayunt, E. A.
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    Associations between PTGS1 gene mutations and aspirin resistance in patients with congenital heart diseases
    (Wiley-Blackwell Publishing, Inc, 2009) Coskun, I.; Atay, Y.; Berdeli, A.; Mecidov, M.; Atay, A.; Ayik, M. F.; Yagdi, T.; Alayunt, E. A.
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    CHA2DS2-Vasc and HAS-BLED Scores as Predictors of Ischemic and Hemorrhagic Stroke Risk After Left Ventricular Assist Device Implantation
    (Elsevier Science Inc, 2015) Kemal, H. S.; Ertugay, S.; Nalbantgil, S.; Zoghi, M.; Engin, C.; Yagdi, T.; Ozbaran, M.
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    CHA2DS2-Vasc and HAS-BLED Scores as Predictors of Ischemic and Hemorrhagic Stroke Risk After Left Ventricular Assist Device Implantation
    (Elsevier Science Inc, 2015) Kemal, H. S.; Ertugay, S.; Nalbantgil, S.; Zoghi, M.; Engin, C.; Yagdi, T.; Ozbaran, M.
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    CHA2DS2-Vasc and HAS-BLED Scores as Predictors of Ischemic and Hemorrhagic Stroke Risk After Left Ventricular Assist Device Implantation
    (Elsevier Science Inc, 2015) Kemal, H. S.; Ertugay, S.; Nalbantgil, S.; Zoghi, M.; Engin, C.; Yagdi, T.; Ozbaran, M.
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    Changes in plasma neprilysin levels after left ventricular assist device implantation and association of outcomes during 1-year follow-up
    (Wiley, 2019) Yuce, E. I. Elif Ilkay; Demir, E.; Simsek, E.; Ozturk, P.; Parildar, Z.; Engin, C.; Yagdi, T.; Ozbaran, M.; Nalbantgil, S.; Gurgun, C.
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    Changes in plasma neprilysin levels after left ventricular assist device implantation and association with short-term outcomes
    (Oxford Univ Press, 2018) Yuce, E. I.; Demir, E.; Simsek, E.; Ozturk, P.; Parildar, Z.; Engin, C.; Yagdi, T.; Ozbaran, M.; Nalbantgil, S.; Gurgun, C.
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    Clinical Characteristics of Obstructive Sleep Apnea Syndrome in Heart Transplant Recipients
    (Elsevier Science Inc, 2013) Ayik, S.; Gungor, H.; Ayik, M. F.; Engin, C.; Yagdi, T.; Nalbantgil, S.; Akhan, G.; Ozberan, M.
    Aim. We investigated the prevalence and clinical characteristics of obstructive sleep apnea syndrome (OSAS) among heart transplantation patients. Methods. Among 86 surviving patients of mean age 43.07 +/- 13.23 years including 35 men transplanted from April 1999 to November 2010, 43 (50%) agreed to participate in this study. Patients with apnea-hypopnea index (AHI) < 5 were labeled as "normal", with an AHI > 5, as obstructive surgeon (OSA). According to the ART, subjects were classified as with OSA (group 1; n = 25 of mean age 49.0 +/- 12.1 years and including 21 men versus non OSA group 2; n = 18) of mean age 34.8 +/- 10.1 years with 14 men. We recorded patient demographic features, medications, polysomnographi observations, laboratory measurements, as well as echocardiographic and angiographic parameters. Results. Prevalence of OSA (AHI > 5) was 58% (n = 25) with 30% (n = 14) as moderate or severe OSA (AHI > 15) OSA patients were significantly older, and showed a greater value of body mass index (BMI) and waist circumference. Echocardiographic findings revealed the only significant difference to be systolic arterial pressure. The apnea-hypopnea index showed significant correlation with age, BMI, waist circumference, neck circumference, Epworth score, duration of apnea episode, time of SaO(2) under 90% and systolic arterial pressure (SPAP). An inverse correlation was observed between ART and sleep efficiency, oxygen saturation, and percentage of time in random eye movement (REM) sleep. Multivariate backward logistic regression analysis indicated waist circumference, sleep efficiency, percentage of time in REM sleeps and duration of apnea episode to be independent predictors of AHI. Conclusion. OSA is prevalent among heart transplantation patients. Obesity is a risk factor and waist circumference, and independent predictor for OSA.
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    Clinical Characteristics of Obstructive Sleep Apnea Syndrome in Heart Transplant Recipients
    (Elsevier Science Inc, 2013) Ayik, S.; Gungor, H.; Ayik, M. F.; Engin, C.; Yagdi, T.; Nalbantgil, S.; Akhan, G.; Ozberan, M.
    Aim. We investigated the prevalence and clinical characteristics of obstructive sleep apnea syndrome (OSAS) among heart transplantation patients. Methods. Among 86 surviving patients of mean age 43.07 +/- 13.23 years including 35 men transplanted from April 1999 to November 2010, 43 (50%) agreed to participate in this study. Patients with apnea-hypopnea index (AHI) < 5 were labeled as "normal", with an AHI > 5, as obstructive surgeon (OSA). According to the ART, subjects were classified as with OSA (group 1; n = 25 of mean age 49.0 +/- 12.1 years and including 21 men versus non OSA group 2; n = 18) of mean age 34.8 +/- 10.1 years with 14 men. We recorded patient demographic features, medications, polysomnographi observations, laboratory measurements, as well as echocardiographic and angiographic parameters. Results. Prevalence of OSA (AHI > 5) was 58% (n = 25) with 30% (n = 14) as moderate or severe OSA (AHI > 15) OSA patients were significantly older, and showed a greater value of body mass index (BMI) and waist circumference. Echocardiographic findings revealed the only significant difference to be systolic arterial pressure. The apnea-hypopnea index showed significant correlation with age, BMI, waist circumference, neck circumference, Epworth score, duration of apnea episode, time of SaO(2) under 90% and systolic arterial pressure (SPAP). An inverse correlation was observed between ART and sleep efficiency, oxygen saturation, and percentage of time in random eye movement (REM) sleep. Multivariate backward logistic regression analysis indicated waist circumference, sleep efficiency, percentage of time in REM sleeps and duration of apnea episode to be independent predictors of AHI. Conclusion. OSA is prevalent among heart transplantation patients. Obesity is a risk factor and waist circumference, and independent predictor for OSA.