Browsing by Author "Iskesen I."
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Item Opening the cardiac chambers does not make any difference in P300 measurement(2006) Iskesen I.; Yilmaz H.; Yildirim F.; Selcuki D.Objective. Cognitive brain dysfunction after open heart surgery is a serious complication caused by cardiopulmonary bypass (CPB). The presence of gaseous and/or particulate emboli in the CPB circuit and cerebral hypoperfusion may be the causes of neurologic problems after cardiac operations. Methods. In this prospective study we examined 42 consecutive cardiac surgery patients (24 mitral valve replacement [MVR] and 18 coronary artery bypass grafting [CABG] patients). In addition to determination of clinical measurements, cognitive brain function was measured objectively by P300 auditory-evoked potentials before operation, at day 7, and at 4-month follow-up. Electroencephalographic evaluations were also performed. Results. In preoperative measures there was no difference between the groups (peak latencies in the MVR group were 324 ± 8 milliseconds; CABG group, 318 ± 6 milliseconds; P > .05). At day 7, cognitive P300 auditory-evoked potentials were significantly impaired (prolonged) in both groups compared to preoperative values (MVR group, 347 ± 7 milliseconds; CABG group, 342 ± 7 milliseconds; P < .05). P300 measurements almost returned to normal at 4-month follow-up (MVR group, 331 ± 6 milliseconds; CABG group, 319 ± 8 milliseconds; P > .05 compared to preoperative values). One week and 4 months after surgery no difference between the 2 groups could be found (P > .05). Conclusion. Postoperative patients had prolonged P300 values according to the preoperative measurements and we have not found any difference between the groups whether cardiac chambers were opened or not. © 2006 Forum Multimedia Publishing, LLC.Item Trimetazidine reduces oxidative stress in cardiac surgery(2006) Iskesen I.; Saribulbul O.; Cerrahoglu M.; Var A.; Nazli Y.; Sirin H.Background: Trimetazidine is an anti-ischemic agent that is used to treat angina and it has cardioprotective effects without inducing any significant hemodynamic changes. It inhibits the long-chain mitochondrial 3-ketoacyl coenzyme A thiolase enzyme in the myocyte and can improve cardiac mitochondrial metabolism, as well as scavenge free radicals. The aim of this double-blind prospective randomized study was to investigate the effect of preoperative use of trimetazidine on the reduction of oxidative stress during coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods and Results: The study group (group T) and the control group (group C) each comprised 12 patients. Pretreatment began 2 weeks before CABG with trimetazidine (60 mg/day po); the control group did not receive any medication. Serial blood samples were collected before and after CPB for measurement of the serum concentrations of these major endogenous antioxidant enzyme systems, which are markers for oxidative degradation of the cellular membranes; postoperative levels were significantly different between the groups (p<0.05). There were no significant difference in hemodynamic values. Conclusion: The findings suggest that pretreatment with trimetazidine alleviates malondialdehyde production and preserves endogenous antioxidant capacity during CABG with CPB and cardioplegic arrest.Item Pentoxifylline affects cytokine reaction in cardiopulmonary bypass.(2006) Iskesen I.; Saribulbul O.; Cerrahoglu M.; Onur E.; Destan B.; Sirin B.H.BACKGROUND: Cardiac surgery is associated with an inflammatory response that may cause myocardial dysfunction after cardiopulmonary bypass. We examined the efficacy of pentoxifylline to attenuate the cardiopulmonary bypass-induced inflammatory response during heart operations. METHODS: In a prospective, randomized study, 30 patients undergoing coronary artery bypass graft surgery received either pentoxifylline (group P, n = 15) (continuous infusion of 1.5 mg/kg per hour during operation) or not (group C [control], n = 15). Blood samples for measurements of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8, and IL-10 were taken from the arterial line in both groups at 5 different time points. RESULTS: TNF-alpha, IL-6, and IL-8 plasma levels increased in both groups after cardiopulmonary bypass, with a higher increase in the control group (P < .05). CONCLUSIONS: Our results indicate that pentoxifylline infusion during cardiac surgery inhibits the proinflammatory cytokine release caused by cardiopulmonary bypass.Item Cardioprotective effect of calcium dobesilate during open-heart surgery(2006) Iskesen I.; Saribulbul O.; Cerrahoglu M.; Onur E.; Tekin C.; Sirin H.Objective - The purpose of this double-blind, controlled, prospective randomized study was to investigate the possible effects of the preoperative use of calcium dobesilate (CLS2210) on the biochemical markers of myocardial injury during open-heart surgery, and to determine if it has any myocardial protective effects. Methods - Twenty-four patients undergoing elective cardiac surgery were included in this study and randomized into two groups. CLS2210 was given orally to 12 patients for 14 days before the operation (CD group), but not to the other 12 patients (control group). Serum CK, CK-MB, myoglobin and troponin-T levels were measured from venous blood samples before and after the operation for evaluation of the effect of this drug against myocardial damage. Blood samples were also taken from the radial artery and the coronary sinus before the institution of cardiopulmonary bypass (CPB), and 2 and 15 minutes after the removal of the cross-clamp in order to measure the lactate levels and calculate the lactate extraction of the myocardium. Results - First, CK-MB levels in patients of the CD group were significantly lower than those of the control group (p < 0.05) at the 2nd and 18th postoperative hour. Second, myoglobin and troponin-T levels in the CD group were significantly lower than those of the control group (p < 0.05) at the 2nd, 18th and 48th postoperative hour. Third, there was a significant difference in lactate extraction calculation values between the groups at the 2nd minute after removal of the cross-clamp (p < 0.05). Conclusions - We concluded that preoperative use of CLS2210 has some beneficial effects in protecting the myocardium and decreasing the myocardial injury during the cardioplegic arrest period in open-heart surgery.Item Huge pulsating cystic cardiac mass(2006) Utuk O.; Bilge A.R.; Bayturan O.; Sirin H.; Iskesen I.; Tezcan U.K.[No abstract available]Item The effect of piroxicam on the prevention of postoperative retrosternal and pericardial adhesions(2007) Iskesen I.; Aksoy O.; Cerrahoglu M.; Sirin H.Background - The presence of adhesions after heart operations increases the risk of life-threatening damage to the heart and extracardiac grafts. Infections, tissue injury and inflammations are sus-pected aetiologic agents. The main purpose of our study is to evaluate the effect of an antiinflammatory agent piroxicam on the formation of retrosternal and pericardial adhesions in a rabbit model. Material and methods - 23 of forty-two New Zealand white rabbits were labelled as group P (piroxicam group) and the others as group C (n = 19, control group). All animals were subjected to median sternotomy and abrasion was applied to the epicardium and pericardium. Piroxicam was given only to group P animals 10 mg/kg/day intramuscularly on the day of operation and twice daily for 2 days postoperatively. All animals were sacrificed on the 10th postoperative day. After cardiectomy, the pericardium was totally excised; retrosternal and pericardial adhesions were evaluated and scored. t-PA (tissue plasminogen activator), PAI-I (plasminogen activator inhibitor-1) levels and pericardial tissue myeloperoxidase activities were measured. Results - More severe retrosternal and pericardial adhesions were observed in the control group (P < 0.05). Mean levels of t-PA were higher in the study group than in the control group (P < 0.05). Mean levels of PAI-I were lower in the study group (P < 0.05). Hence pericardial fibrinolytic capacity was significantly higher in the piroxicam group than in the control group. Myeloperoxidase activities in the pericardium were significantly lower in the study group than in the control group (P < 0.05). Conclusion - The use of piroxicam in the perioperative period prevents inflammation, preserves the fibrinolytic capacity of the pericardium and decreases the postoperative pericardial and retrosternal adhesions.Item Follow-up with objective and subjective tests of the sleep characteristics of patients after cardiac surgery(2007) Yilmaz H.; Iskesen I.Background: The purpose of this study was to investigate the changes in sleep characteristics in patients who underwent coronary artery bypass grafting (CABG) surgery, using both subjective and objective tests in the early (preoperative) and late (postoperative) periods. Methods and Results: Forty-five patients who underwent CABG and did not previously have any sleep disturbance were evaluated by subjective and objective sleep parameters during a consecutive 3-5-day preoperative examination, during a consecutive 5-8-day period in the 1st postoperative week, and during consecutive 5-8-day periods in the 1st and 2nd postoperative months. The Pittsburgh Index and Epworth Sleepiness Scale values, sleep latency, napping episodes, total napping period, duration of wakefulness after sleep onset and fragmentation index values were significantly increased; however, Maintenance of Wakefulness Test lengths, total sleep time and sleep efficiency were significantly decreased in the 1st postoperative week. All of these were the same in the 1st postoperative month and differences were not statistically different from the preoperative period. None of the sleep parameters in the 2nd postoperative month differed from the values obtained in the preoperative period. Conclusion: The cause of sleeplessness after CABG surgery may be temporary deterioration of circulation in the centers of the brain stem and hypothalamus that control sleep and awakening. Improvement of the circulation in these centers a few months after the operation helps to regain sleep control, and thus sleep disturbances disappear.Item Late daytime naps may cause drowsiness after coronary bypass graft operation in the first postoperative week(2007) Yilmaz H.; Iskesen I.[No abstract available]Item Objective and subjective characteristics of sleep after coronary artery bypass graft surgery in the early period: A prospective study with healthy subjects(2007) Yilmaz H.; Iskesen I.Background. The purpose of this study was to investigate changes in sleep characteristics by examining both subjective tests and objective parameters such as actigraphic sleep analysis in patients who underwent coronary artery bypass graft surgery (CABG). Patients and Methods. Forty-five patients who underwent CABG operations and did not have any sleep disturbance were examined. They were evaluated by subjective and objective sleep parameters at the beginning of the examination and on the fifth postoperative day. Forty healthy subjects who did not undergo the operation were also evaluated. Results. The Pittsburgh Index and Epworth values in the postoperative group were significantly higher, but Maintenance of Wakefulness Test lengths were significantly shorter than in the preoperative and control groups. Sleep latency, napping episodes, total napping periods, and fragmentation index values of the postoperative group were significantly higher, but sleep efficiency values were significantly lower than in the preoperative and control groups. Conclusion. The cause of sleeplessness after CABG surgery may be the temporary deterioration of circulation in the centers of the brain stem and hypothalamus, which control sleep and awakening. It can be proposed that the improvement of the circulation in these centers a couple of months after the operation help to regain sleep control, and thus sleep disturbances disappear. © 2006 Forum Multimedia Publishing, LLC.Item N-terminal proBNP levels can predict cardiac failure after cardiac surgery(2007) Cerrahoglu M.; Iskesen I.; Tekin C.; Onur E.; Yildirim F.; Sirin B.H.Background: The aim of this study was to evaluate the relationship between the preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and the need for the inotropic support in the early postoperative period of patients undergoing coronary artery bypass graft surgery. Methods and Results: The patients were divided into 2 groups: NT-proBNP level <220 pg/ml (group A, n=26) or >220 pg/ml (group B, n=26). The normal value for NT-proBNP level was accepted as <220 pg/ml. The cardiac output was measured on arrival in intensive care and at the 16th hour. The groups were compared with respect to early postoperative hemodynamic measurements, urinary output, use of inotropic agents and requirement for additional cardiac-assist devices. Left ventricular ejection fraction, cardiac output and cardiac index were lower in group B and inotropic agents were used for a longer period of time and at higher doses in this group (p<0.05). Conclusion: Measurement of the NT-proBNP level in the period before cardiac surgery can indicate the postoperative prognosis of the patient and may be a predictor of the need for postoperative inotropic treatment.Item An alternative method of prosthetic mitral valve implantation in the presence of extensive calcification(2007) Sirin B.H.; Iskesen I.; Erbuyun K.Annular calcifications carry some technical difficulties for success in conventional valve surgery. In this paper we present an easy alternative mitral valve replacement method applied for a patient with a heavily calcified mitral annulus. Excision of both leaflets and partial resection of the annular calcification with an ultrasonic dissector allowed the intra-atrial insertion of a 33-mm Omnicarbon monoleaflet prosthetic valve through a smaller opening of the left posterior atrium. The technical difficulties in inserting a prosthetic valve in a patient with a heavily calcified mitral annulus are discussed.Item Congenitally corrected transposition of the great arteries plus dextrocardia operated with an unusual operative technique(2008) Sirin B.H.; Kurdal A.T.; Iskesen I.We describe a case of congenitally corrected transposition of the great arteries plus dextrocardia and normal anatomical abdominal viscera. Systemic (tricuspid) valve replacement was performed due to moderately severe valve regurgitation. An unusual operative technique was used because of the patient's rare morphology. On cardiopulmonary bypass, the systemic valve was approached via a left atriotomy anterior to the left pulmonary veins, whereby the surgeon was positioned on the patient's left side. As the surgeon had excellent exposure from the opposite side of the table, he was able to perform a tricuspid valve replacement through the left atrium. Our aim is to share our limited experience of such cardiac morphology, which may oblige the surgeon to be positioned on the left side of the table to perform systemic valve surgery. © Georg Thieme Verlag KG Stuttgart.Item An uncommon cause of pulsation on the left side of the thorax. Case report(Edizioni Luigi Pozzi S.r.l., 2009) Sirin B.H.; Iskesen I.; Kurdal A.T.A 70 years old man affected by clinical findings of congestive heart failure eight months after aneurysmectomy of a true left ventricular aneurysm, presented with actual pseudoaneurysm of the left ventricle. There was a 5 × 5 cm soft tissue mass on the left side of the chest, synchronously pulsating with heart beating. The repair was performed with the aid of cardiopulmonary bypass. Myocardial tissues were approximated and closed by using two Teflon stripes. BioGlue was applied on the sutures and between the stripes. Although there is a significantly high mortality of the pseudoaneurysm cases their repair can and should be performed in an urgent procedure.Item Left ventricle perforation and pseudoaneurysm with an unusual presentation of a patient with stomachache. Case report(Edizioni Luigi Pozzi S.r.l., 2009) Hayrettin Sirin B.; Iskesen I.; Taner Kurdal A.A 49-year-old man admitted with a 3 weeks history of stomachache and without any cardiac symptoms and diagnosed as pseudoaneurysm of the left ventricle is reported. The repair was performed with the aid of cardiopulmonary bypass, defect was repaired with Gore-tex patch and myocardial tissues were approximated and closed by using two Teflon stripes. BioGlue was applied on the sutures and between the stripes. We report this unusual case because rarity and high clinical index of suspicion is needed to make correct diagnosis in such patients. Although there is a significantly high mortality of the pseudoaneurysm cases their repair can and should be performed as an urgent procedure.Item Pleura Preservation during coronary operation does not have any beneficial effect on respiratory functions(2009) Iskesen I.; Kurdal A.T.; Yildirim F.; Cerrahoglu M.; Sirin H.Aim According to some reports the destruction the integrity of the pleura during acute myocardial infarction (AMI) harvesting during coronary surgery may also impair respiratory function in the postoperative period. The purpose of this study was to evaluate the influence of preserved integrity of pleura on respiratory function in patients undergoing coronary artery bypass grafting (CABG). Methods. One hundred and forty-three patients who had on-pump-CABG operation with pedunculated LIMA graft were divided to 2 groups. The first group is the study group that pleura opened (group OP; N=69), and the other group is that their pleura protected (group C, N=74). All patients were evaluated with using respiratory function test parameters (functional vital capacity [FVC], force expiratory volume %-at the 1st second [FEV1%] in the preoperative period and on the 7th postoperative day). Respiratory problems, blood drainage amounts and used blood products in the postoperative period were measured. Results. Preoperative FVC values were not different between the two groups (3.08±0.5 in group C and 3.37±0.7 L in OP group) (P>0.05). On the VII postoperative day this parameter did not show any significant difference between the groups (2.80±0.6 in group C and 2.75±0.5 liter in OP group) (P>0.05). Preoperative FEV1% values did not show any difference (77.6±4.6% and 76.0±2.7% in OP and C groups respectively. There was no significant difference between the postoperative FEV1% values (71.8±5.1% and 73.4±6.3% respectively) (P>0.05). Patients with protected pleura had significantly lower blood drainage and whole blood unit transfusion (P<0.05). Conclusion. Preservation of the pleural integrity during LIMA harvesting significantly reduces postoperative bleeding but not affects pulmonary functions.Item Trimetazidine may protect the myocardium during cardiac surgery(2009) Iskesen I.; Kurdal A.T.; Eserdag M.; Cerrahoglu M.; Sirin B.H.Background: Trimetazidine is an anti-ischemic agent with cardioprotective effects. The purpose of this double-blind, controlled, prospective randomized study was to investigate the possible effects of the preoperative use of trimetazidine on the biochemical markers of myocardial injury during open heart surgery and to determine if it has any myocardial protective effects. Methods: Thirty patients undergoing coronary artery bypass grafting surgery, received either trimetazidine (study group, n = 15) or not (control group, n = 15). Pretreatment began 2 weeks before the operation with trimetazidine (60 mg/day orally), and the control group received no medication. We measured the levels of serum creatine kinase (CK), CK isoenzyme MB (CK-MB), myoglobin, and troponin T in venous blood samples obtained before and after the operation to evaluate the effect of this drug against myocardial damage. We also took serial blood samples from the radial artery and the coronary sinus before the institution of cardiopulmonary bypass (CPB) and at 2 and 15 minutes after the removal of the cross-clamp to measure lactate levels and calculate the lactate extraction of the myocardium. Results: Postoperative levels of myoglobin, troponin T, CK, and CK-MB were significantly lower in the trimetazidine group than in the control group (P < .05). There was also a significant difference in the values for the lactate extraction calculation between the groups at minute 2 after the removal of the cross-clamp (P < .05). Conclusion: We conclude that pretreatment with trimetazidine has some beneficial effects in protecting the myocardium and decreasing myocardial injury during the cardioplegic arrest period in open heart surgery without affecting postoperative hemodynamics. © 2009 Forum Multimedia Publishing, LLC.Item Preoperative oral pentoxifylline for management of cytokine reactions in cardiac surgery(2009) Iskesen I.; Kurdal A.T.; Kahraman N.; Cerrahoglu M.; Sirin B.H.Background: Cardiopulmonary bypass may lead to many inflammatory responses that may cause myocardial dysfunction after open heart surgery. We aimed to investigate the effect of preoperative pentoxifylline treatment to reduce the occurrence of cardiopulmonary bypass-induced inflammatory response. Methods: In a prospective, randomized study, 40 patients undergoing coronary artery bypass graft surgery received either pentoxifylline (study group, n = 21) or not (control group, n = 19). Pretreatment with pentoxifylline (800 mg/day orally) was started 5 days before the operation. Blood samples for measurements of tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 from the arterial line, and venous blood samples for creatine kinase (CK) and CK isoenzyme fraction MB (CK-MB) were taken in both groups at 5 different time points. Hemodynamic parameters were measured with the thermodilution technique. Results: TNF-α, IL-6, and IL-8 plasma levels increased in both groups after cardiopulmonary bypass, with a greater increase in the control group (P < .05). There were no significant differences between the groups for the values of CK-MB and hemodynamic parameters. Conclusions: We conclude that pretreatment with oral pentoxifylline before cardiac surgery inhibits proinflammatory cytokine release caused by cardiopulmonary bypass and has some beneficial effects in protecting the myocardium during the cardioplegic arrest period in open-heart surgery, without affecting postoperative hemodynamics. © 2009 Forum Multimedia Publishing, LLC.Item Protection of saphenous vein craft from arterial pressure an experimental study(2009) Kurdal A.T.; Ustundag N.; Güven A.; Iskesen I.; Bozkurt K.; Sirin B.H.Background: Reoperations for bypass surgery increase the need for new grafts, We investigated early changes in both the normal human saphenous vein and in ectatic varicose veins externally supported by PTFE (polytetrafluoroethylene) graft and exposed to arterial pressure in an in vitro non-pulsatile flow model. Material and Methods: A total of 24 saphenous vein pieces ( 11 of them normal, the other 13 with varicosities) with a length of 6 centimeters were divided into equal parts; half of these parts were wrapped in PTFE grafts, All vein parts were placed in a perfusion circuit, Tissue biopsies were obtained from the vein segments, Light and electron microscopy examinations were performed, and endothelial continuity, elastic laminate continuity, medial connective tissue uniformity, medial smooth muscle uniformity, and adventitial con-nective tissue uniformity parameters were identified. Results: All parameters in the PTFE protected vein groups were better, The fewest morphological changes among all four groups were detected in the vein walls from normal veins with PTFE protection. There was no significant difference in endothelial continuity and adventitial connective tissue uniformity between the normal vein group and the varicose vein group with PTFE protection. Conclusions: It is suggested that supporting vein grafts externally with PTFE sufficiently protects the vein walls against damage from exposure to arterial pressure, If varicose veins are used as arterial grafts, supporting them with PTFE may be useful because of the good protection of endothelial and medial connective tissues, resulting in similar parameters to those of normal vein walls. © Georg Thieme Verlag KG Stuttgart New York.Item Calcium dobesilate reduces oxidative stress in cardiac surgery(2009) Cerrahoglu M.; Taner Kurdal A.; Iskesen I.; Onur E.; Sirin H.Aim. Calcium dobesilate (CD) is a synthetic benzene sulfonate derivative and an angioprotective agent used orally. It can be used in patients who have diabetic retinopathy or chronic venous insufficiency. The aim of this study was to investigate the effect of CD on the reduction of oxidative stress during coronary artery bypass graft operations on cardiopulmonary bypass. Methods. A double-blind prospective randomized study was carried out on 30 patients who underwent coronary artery bypass operations. The control and study groups were composed of 15 patients each. Pretreatment with CD started two weeks before the operation. Serial blood samples for superoxide dismutase, glutathione peroxidase were collected for the serum concentration measurements of the major endogenous antioxidant enzyme systems and malondialdehyde for scavenging capacity. Results. After the release of cross clamp levels of superoxide dismutase and glutathione peroxidase. they were significantly higher in the study group than in the control group (P<0.05). Malondialdehyde levels in the study group were significantly lower than those of the control group (P<0.05). The cardiac function after aortic declamping was affected by CD, indicating contribution of CD to myocardial injury from ischemia/reperfusion. Conclusion. The study suggests that pretreatment with CD alleviates malondialdehyde production and preserves endogenous antioxidant capacity during cardiopulmonary bypass and cardioplegic arrest.Item Sleep disturbances after cardiac surgery with or without elevated S100B levels(2009) Iskesen I.; Kurdal A.T.; Yilmaz H.; Cerrahoglu M.; Sirin B.H.Objective - The aim of the study was to investigate sleep disturbances of cardiac surgery patients with or without elevated S100B levels. Methods and results - Twenty-two patients with serum S100B > 0.3 μg/l (study group) 12 hours after cardiac surgery with cardiopulmonary bypass and 23 patients with serum S100B < 0.3 (control group) were investigated in a prospective study. They were evaluated with the use of objective sleep tests. Cardiopulmonary bypass has negatively affected the sleep characteristics in the postoperative period for both groups. Maintenance wakefulness test, total sleep time, total activity score and sleep efficiency scores were significantly shorter in the study group in the postoperative period. Sleep latency, percentage of wakefulness after sleep onset, daytime napping episodes and total nap duration in the same period were significantly higher than in the control group. Conclusion - Cardiac surgery affects a patient's sleep characteristics. Patients with elevated S100B values have more sleep disturbances after cardiac surgery than patients with normal S100B values.