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    Comparing the effectiveness of neutrophil-lymphocyte ratio as a mortality predictor on middle and advanced age coronary artery bypass graft patients
    (Kare Publ, 2014) Ay, Derih; Erdolu, Burak; Yümün, Gündüz; Aydın, Ufuk; Demir, Ahmet; Tiryakioglu, Osman; Vural, Ahmet Hakan
    OBJECTIVE: In this study, the effect of neutrophil-lymphocyte ratio (NLR), which is a recently developed inflammatory parameter, as an early stage mortality predictive marker on coronary artery bypass (CABG) patients of various age groups was examined. METHODS: Seventy eight patients under the age of 45 (Group 1) and 80 patients who were older than 45 (Group 2) randomly chosen from the patients who underwent isolated CABG surgery, were examined. The preoperative characteristics and NLRs were noted. The primary end point of the study was determined as all-cause in- hospital mortality. RESULTS: Mortality was observed in 2 patients in Group 1 and 11 patients in Group 2. The threshold value of NLR was 2,47 in the Receiver Operating Characteristic (ROC) curve in Group 1 and there wasn't any significant correlation between preoperative NLR and mortality rates in the patients whose NLRs were above this curve. The threshold value was determined as 4.07 in Group 2 and there was a significant relation between preoperative NLR and mortality (p<0,01). No relation was found between NLR and mortality when all the examined patients were considered (p>0.05). CONCLUSION: NLR that can be easily calculated, can be used as a mortality predictor in the patients of ad vancedage who will undergo isolated CABG procedure.
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    Deep Sternal Wound Infection after Coronary Artery Bypass Surgery: Management and Risk Factor Analysis for Mortality
    (Forum Multimedia Publishing, Llc, 2014) Yümün, Gündüz; Erdolu, Burak; Toktaş, Faruk; Eriş, Cüneyt; Ay, Derih; Türk, Tamer; As, Ahmet Kağan
    Background: Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. Methods: Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. Results: In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. Conclusions: Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.
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    Effects of moderate pressure distention on the proximal and distal sections of the saphenous vein
    (E-Century Publishing Corp, 2016) Yümün, Gündüz; Gür, Özcan; Gelincik, İbrahim; Ay, Derih; Donbaloğlu, Mehmet Okan; Gürkan, Selami; Özkaramanlı Gür, Demet
    Studies have shown that the distention and traction of a vein leads to the loss of cells and the function of the endothelia. Here, we aimed to compare the effects of pressure distention on the proximal and distal parts of the saphenous vein. Twenty patients were enrolled in this study. The proximal and distal saphenous vein segments were distended to three different pressure levels for two minutes: 100 mmHg, 200 mmHg, and 300 mmHg. In addition, the proximal and distal parts of the saphenous vein were compared with the immunohistochemical examinations and the organ bath system. The endothelial cell loss was similar in the proximal and distal segments at 300 mmHg. However, the endothelial cell loss rate was greater in the proximal segments than the distal segments at 100 mmHg and 200 mmHg (P=0.02 and P=0.06, respectively). The relaxation response of the proximal samples distended to 100 mmHg and 200 mmHg was significantly decreased when compared to the distal segment samples (P=0.049 and P=0.047, respectively). Furthermore, there was no relaxation response in the segment samples distended to 300 mmHg. While preparing the graft, inflations with pressures lower than 100 mmHg result in less endothelial damage, and are relatively protective on the graft functions. In this study, we have shown that the endothelial tissue of the distal saphenous vein is more resistant to moderate pressure.