Browsing by Author "Yildirim F."
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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 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 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 The effect of beta-blocking agents on morbidity und mortality following coronary artery bypass surgery; [Kronik beta bloker kullaniminin koroner baypas cerrahisi sonrasi morbidite ve mortalite üzerine etkileri](2013) Öztürk T.; Koçan A.A.; Yildirim F.; Alp D.; Kurdal T.Objective: Aim of this study was to investigate the effect of beta-blocking agents on both short and long-term morbidity and mortality in patients undergoing coronary artery bypass surgery. Material and Methods: Between January 2010 and March 2012, the patients undergoing coronary artery bypass surgery in our cardiovascular surgery clinic were divided into two groups; Group B included the patients who had (Group B) or had not (Group C) been using beta-blocking agents preoperatively, Demographic and clinical characteristics, intraoperative and postoperative clinical parameters as well as short (30-days) and long-term (1 year) rates of morbidity and mortality were retrospectively evaluated. Results: Number of patients with atrial fibrillation was significantly lower in Group B (n=17, 20% vs. n=28, 35%; p<0.01). Frequency of agitation-delirium in Group B was also significantly less than Group C (n=2, 3% vs. n=8, 10%; p=0.05). Thirty-day morbidity was also higher in Group C than Group B (n=28, 35% vs. n=17, 20%; p<0.04), however this difference disappeared after 1 year (n=30 38% vs. n=24, 28%; p=0.2). Neither 30-day nor 1 year-mortality rates were statistically significant between Groups B and C (p=0.4 and p=0.2, respectively). Conclusion: Compared to the control group, the frequencies of both atrial fibrillation and agitation-delirium were significantly lower in Group B in this cohort of patients. The long term use of beta-blocking agents prior to coronary artery bypass surgery appears to markedly reduce 30-day morbidity, despite this effect was not reflected on short and long-term mortality rates.Item Fentanyl reaction in a parkinsonian patient receiving monoamine oxidase inhibitor while undergoing cardiac surgery; [Kardiyak cerrahi geçiren ve monoamin oksidaz inhibitörü kullanan parkinson hastasinda fentanil reaksiyonu](Turkish Anaesthesiology and Intensive Care Society, 2014) Öztürk T.; Çikrikci C.; Yildirim F.; Kurdal A.T.; Çivi M.Use of fentanyl is a controversial issue because of possible adverse drug interactions in patients using monoamine oxidase inhibitors during cardiac surgery. In this case report we described a drug interaction with fentanyl in a parkinsonian patient who was 57 years old, 45 kg weigh and required mitral valve replacement surgery while he was taking a selective monoamine oxidase inhibitor type B (Rasajilin) with selective serotonin reuptake inhibitor (paroxetin). Despite anesthesia and surgery were maintained normally, supraventricular tachycardia, hypertension, sweating, flushing and hypertermia were observed during warming of the heart and the weaning period of cardiopulmonary bypass. Tachycardias were treated by cardioversion and beta-blocker therapy. Patient's body temparature was controlled at 37°C by using pump perfusion. Fentanyl infusion was discontinued. After hemodynamic stability was achieved, cardiopulmonary bypass was terminated. Total fentanyl consumption was 2.8 mg. Parkinson's therapy was resumed at the first day postoperatively. Patient was discharged at the 7th day.Item Coagulation effects of hydroxyethylstarch versus modified fluid gelatin when used as normovolemic hemodilution solutions during cardiac surgery(Turkish Anaesthesiology and Intensive Care Society, 2014) Öztürk T.; Topçu I.; Tuncer B.; Açikgöz B.; Yildirim F.; Işkesen I.Objective: The aim of this study to examine the effects of hydroxyethyl starch and gelatin solutions used for acute normovolemic hemodilution on coagulation during coronary artery bypass surgery. Material and Method: Seventy-two patients undergoing elective coronary artery bypass graft surgery randomly received no hemodilution (control), or 6% HES 200/0.5 (n=24) or 4% gelatin solution (n=24) for acute normovolemic hemodilution before cardiopulmonary bypass. Thromboelastography parameters were measured before (T0) and after (T1) acute nor-movolemic hemodilution, and one (T2) and four (T3) hours after separation from CPB. Results: The R (reaction) time in HES was significantly longer than in controls at T(2) (p=0.03). The K (coagulation) values in group HES and GEL were significantly longer than in controls at T(2) and T(3) (p=0.02 and 0.03, respectively). Rapidity of clot formation (alpha angle) was significantly smaller in HES and GEL compared to controls (p=0.01 and p=0.02, respectively). Maximum amplitudes in HES and GEL were not significantly different than controls at T(2) (p=0.3 and 0.9, respectively). At T2, three patients in GEL (but none in HES) showed clotlysis at 30 min (p=0.1). GEL and HES received fewer units of erythrocyts compared to controls(p<0.001); however, use of fresh frozen plasma was not significantly different than in controls. Mediastinal blood loss was greater in group HES than in controls (p<0.05). Conclusion: Performing acute normovolemic hemodilution with HES and GEL solutions caused significant change in coagulation state by thromboelastography, reduced the need for errytrocyt. Regarding the increase in mediastinal chest drainage, we concluded that HES may not be safety in patients undergoing coronary surgery.Item Surgical treatment of a post-traumatic femoral arteriovenous fistula; [Posttravmatik dev femoral arteriovenöz fistülün redo operasyonu](Anatolian Journal of Clinical Investigation, 2014) Yildirim F.; Tetik Ö.; Besir Y.; Kestelli M.; Sürer S.; Gürbüz A.One of the leading causes of arteriovenous fistulae (AVF) is trauma on the vascular course and its vicinity. Untreated traumatic AVF may cause aneurysmal dilation of the involved artery and vein. Herein, we present the case of a patient in whom a progressive dilatation of both left femoral and iliac arteries and veins developed consequent to a post-traumatic femoral AVF 35 year after injury. The patient was surgically treated and a vertical incision was performed on common femoral artery identifying the fistula tract within it and it was closed using 5-0 polypropylene suture and the patient had an uneventful, complete recovery. © 2014, Anatol J Clin Investig. All rights reserved.Item Ultrasound-guided catheter-directed foam sclerotherapy for great saphenous vein(Edizioni Minerva Medica, 2015) Kurdal A.T.; Yildirim F.; Ozbakkaloglu A.; Iskesen I.; Tetik O.Aim: The problem of varicose veins in the lower leg is a common disease and associated with long-term morbidity. It has usually been treated using high ligation with stripping and endovenous ablation surgery of the great saphenous vein. The aim of this paper is to report our own series of patients treated by ultrasound guided catheter directed foam sclerotherapy for the chemical ablation of great saphenous vein. Methods. The study involved 108 legs with symptomatic varicose veins (C2-4) secondary to great saphenous vein insufficiency. The great saphenous vein was accessed at knee level. With the method of Tessari sclerosant foam was made (2 mL 3% polidocanol and 8 mL air) and delivered along the great saphenous vein while the catheter was withdrawn. At two and fifty two weeks after treatment the patients were evaluated. Results. Catheter-directed foam sclerotheraphy was successfully performed in all of the patients. Venous Clinic Severity Score was reduced significantly (P<0.05). Eighty nine percent of the GSV were completely occluded, 4% were partly occluded and 7% were recanalized. No serious side-effects occurred. Conclusion. Catheter-directed foam sclerotheraphy is a safe, simple and minimally invasive procedure. Patient satisfaction was good and the occlusion rate is promising after a single treatment.Item Is "attenuation of Oxidative Stress" Helpful to Understand the Mechanism of Remote Ischemic Preconditioning in Cardiac Surgery?(W.B. Saunders, 2016) Yildirim F.; Iskesen I.; Kurdal A.T.; Ozturk T.; Taneli F.; Gozukara C.; Ozbakkaloglu A.Objectives The aim of this study was to determine the effect of remote ischemic preconditioning (RIPC) on markers of cardiac ischemia and response to oxidative stress in patients undergoing coronary artery bypass grafting (CABG) surgery. Design A prospective, randomized, and blinded study. Setting A single-center university hospital. Participants This study included patients who underwent isolated CABG surgery with cardiopulmonary bypass who were selected carefully to prevent confounding with factors known to affect markers of ischemia-reperfusion and response to oxidative stress. Interventions The authors randomly assigned patients to RIPC to the left lower extremity using a blood pressure cuff (study group) or a cuff that was applied but not inflated or deflated (control group). Measurements and Main Results At 6 hours after CABG surgery, high-sensitivity cardiac troponin T levels were significantly lower in the study group than in the control group. Levels of superoxide dismutase, an antioxidant enzyme, were significantly greater 15 minutes after release of the cross-clamp in the study group, whereas malondialdehyde levels were lower (not significantly) at 1 and 15 minutes after release of the cross-clamp. Hemodynamic parameters were not significantly different at any time point during the study. Conclusions The authors' method of RIPC before CABG surgery resulted in less myocardial ischemia, as indicated by lower troponin levels. Changes in levels of endogenous antioxidant enzymes supported the hypothesis that this protection from ischemia-reperfusion injury was related to scavenging of free oxygen radicals. Future studies might include a more heterogeneous population and medications that lower the body's response to oxidative stress. © 2016 Elsevier Inc.Item Management of a patient with giant aneurysms in the popliteal and coronary arteries(Oxford University Press, 2016) Yildirim F.; Senarslan D.A.; Ozturk T.; Tetik O.Coexistence of multiple peripheric arterial and coronary artery aneurysms of different sizes is extremely rare in young adults. We present a case of rare giant coronary aneurysm and concurrent giant left popliteal aneurysm treated with classical open repair. © 2016 The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.Item Thromboelastogram reduces blood use by inspecting coagulation in heart surgery(SAGE Publications Inc., 2016) Yildirim F.; Tuncer B.; Ozbakkaloglu A.; Kurdal A.T.; Ozturk T.; Iskesen I.Objective Blood transfusion after coronary artery bypass surgery is carried out according to general coagulation tests and blood counts. Our aim was to determine the effects of rotational thromboelastography results on the amount of blood products used in the intraoperative and postoperative periods in coronary artery bypass patients. Methods Our study included 164 patients who underwent coronary artery bypass. A control group was formed from 82 patients picked from hospital records, who had elective coronary artery bypass before the introduction of rotational thromboelastography in our clinic. Blood transfusion was performed in this group according to conventional laboratory data. The study group comprised 82 patients who had elective coronary artery bypass after the introduction of rotational thromboelastography. Blood transfusion was performed in the study group according to rotational thromboelastogram results. The amounts of blood products used in the 2 groups were compared. Results There were statistically significant decreases in the intraoperative and postoperative amounts of packed red blood cells (p = 0.012 and p = 0.006) and postoperative whole blood (p = 0.013) used in the study group compared to the control group. Postoperative bleeding was also significantly reduced (p = 0.001) in the study group. Conclusion Blood transfusion is an important issue after coronary artery bypass, and because of the decreased amount of blood products used, a rotational thromboelastography-based blood transfusion algorithm should be applied in patients undergoing coronary artery bypass. © 2014 SAGE Publications.Item Ultrasound-guided catheter-directed foam sclerotherapy for great saphenous vein; [Uitrascha11geführte, kathetergestutzte schaumsklerotherapie der vena saphena magna](Viavital Verlag, 2016) Kurdal A.T.; Yildirim F.; Ozbakkaloglu A.; Iskesen I.; Tetik O.[No abstract available]Item Bentall Operation in a Patient with Severe Hemophilia A and Marfan Syndrome by Use of a Biologic Composite Graft(Elsevier USA, 2016) Yildirim F.; Ozbakkaloglu A.; Ozturk T.; Tetik O.We describe a patient with severe hemophilia A and Marfan syndrome who underwent an elective Bentall operation. Because of the severe hemophilia, anticoagulation could not be given postoperatively; thus, a biologic Valsalva conduit graft was used. During the procedure, factor VIII was given as a bolus dose just before incision, then by continous infusion intraoperatively to maintain the factor VIII activity level between 200% and 300%. Minimal postoperative bleeding occurred. The infusion was continued postoperatively at a lower dose until all chest tubes, pacing wires, and invasive catheters were removed. The patient was discharged on postoperative day 7 without adverse events. © 2016 The Society of Thoracic Surgeons.Item Three Cases of Large-Diameter True Brachial and Axillary Artery Aneurysm and a Review of the Literature(Elsevier Inc., 2019) Senarslan D.A.; Yildirim F.; Tetik O.Aneurysms of the upper extremity mostly originate from trauma, mycotic lesions, thoracic outlet syndrome, previous arteriovenous fistulae, and atherosclerosis. True aneurysms of the brachial and axillary artery are encountered rarely. They can be diagnosed by simple physical examination as a pulsatile mass. However, most of these aneurysms remain asymptomatic until a complication occurs. The primary complication seen with the axillary or brachial artery is embolization. We report 3 large-diameter true brachial artery aneurysms extending to the axillary zone. One of the patients had distal digital emboli causing gangrenous lesions at the finger tips and the other 2 patients had pain and ischemic symptoms in the forearm. All underwent surgical repair. After excision of the aneurysmal segment, arterial continuity was ensured by interposition of a reversed saphenous vein in 2 patients and with a biological vascular graft in 1 patient. Although endovascular techniques are improving, most true brachial artery aneurysms are not anatomically suitable for interventional procedures. Open surgery still preserves its value. © 2018 Elsevier Inc.Item Improved mechanical performance of three-dimensional woven glass/epoxy spacer composites with carbon nanotubes(SAGE Publications Ltd, 2021) Yildirim F.; Aydin M.; Avci A.Three-dimensional polymer composites offer various features and design options due to their hollow structure and lightweight. However, to exploit their advantages, it is a must to improve their structural features and mechanical performances including out-plane direction. Although introducing thermoplastic fillers between the plies or multilayered design addresses on this critical issue, the benefits offered by the nanoparticles with superior mechanical properties come a step forward as an another engineering solution. Based on this motivation, the goal of this study is to investigate the impact of multiwalled carbon nanotubes on the mechanical and thermomechanical performances of three-dimensional woven glass/epoxy spacer composites. Therefore, multiwalled carbon nanotubes at various content were introduced into epoxy matrix, and the multiwalled carbon nanotubes–epoxy mixture was infused to three-dimensional woven fabric with the vacuum-assisted resin transfer method. The obtained results indicated that the three-point bending strength and modulus were enhanced up to 25 and 80% for warp direction and enhanced up to 44 and 85% for weft direction with carbon nanotube addition, respectively. Tensile strength developed in the warp direction by 7%, while the strength value in the weft direction did not change. The tensile strain values for warp and weft directions enhanced up to 19 and 12% with carbon nanotube addition, respectively. In addition, thermomechanical analysis has revealed that the glass transition temperature and storage modulus were also improved. Particle dispersion detection with color measurement and scanning electron microscopy analyses revealed the effectiveness of the ultrasonic mixing on the dispersion of carbon nanotubes in the epoxy matrix. The consequences of carbon nanotube addition on microscale morphology were discussed based on the fracture morphologies to nanoscale and microscale toughening mechanisms in the existence of carbon nanotube reinforcement. © The Author(s) 2021.Item Systemic inflammatory response during cardiopulmonary bypass: Axial flow versus radial flow oxygenators(SAGE Publications Ltd, 2022) Yildirim F.; Amanvermez Senarslan D.; Yersel S.; Bayram B.; Taneli F.; Tetik O.Background: The objective of this study was to investigate the inflammatory effects of different oxygenator flow pattern types in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. Methods: We designed this randomized, single-blind, prospective study of patients with coronary artery disease. We compared the systemic inflammatory effects of oxygenators with two types of flow: axial flow and radial flow. Therefore, we divided the patients into two groups: 24 patients in the axial group and 28 patients in the radial group. IL-1, IL-6, IL-10, and TNF-α were examined for cytokine activation leading to a systemic inflammatory reaction. The samples were collected at three different time intervals: T1, T2, and T3 (T1 was taken before cardiopulmonary bypass, T2 just 1 h after CPB onset, and T3 was taken 24 h after the surgery). Results: There were no significant differences in demographic characteristics between the two groups. We observed that there were notably lower levels of humoral inflammatory response parameters (IL-1, IL-6, and TNF-α) in the radial flow oxygenator group than in the axial flow group at the specific sampling times. For IL-10, there was no significant difference for any time period. Conclusion: It might be advantageous to use a radial-flow-patterned oxygenator to limit the inflammatory response triggered by the oxygenators in cardiopulmonary bypass. © The Author(s) 2022.Item Efficacy and cost-effectiveness of cell saver usage in the repair of thoracic aortic aneurysms and dissections(SAGE Publications Ltd, 2022) Amanvermez Senarslan D.; Yildirim F.; Kurdal A.T.; Damar A.; Ozturk T.; Tetik O.Introduction: A substantial amount of blood loss occurs during the open repair of aortic aneurysms or dissections. The aim of the present study is to determine the efficacy and cost-effectiveness of cell saver devices in blood conservation during the open repair of thoracic aortic pathologies. Methods: The present study prospectively collected the data pertaining to 25 patients who underwent surgical management of thoracic aortic aneurysms or dissections using a cell saver (Group 1, n = 25). The volume and cost of transfusion and postoperative outcomes were compared with the second group of patients who underwent surgery without the use of cell savers in the previous year (Group 2, n = 25); the data pertaining to the same were retrospectively collected from the hospital records. The patient characteristics and categorical variables were compared using the x2 test and Fisher’s exact test. Transfusion volume and costs were compared using the independent samples t-test and Mann–Whitney U test. Results: The patients in both the groups displayed similar characteristics and risk factors. The total volume of allogenic red blood cell (p < 0.001) and total blood product (p = 0.01) transfusions were significantly lower in Group 1. The cost of red blood cell (p < 0.001) and total transfusions (p = 0.03) were lower in Group 1. The two groups displayed similar in-hospital morbidity and mortality rates. Conclusions: There was a significant association between the use of cell savers and the decreased need for red blood cell and total blood product transfusions. Considering the cost of the cell saver set, transfusion costs in the two groups were comparable. © The Author(s) 2021.