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  • Küçük Resim
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    Comparison of vasodilatation responses of arterial grafts harvested with and without electrocautery: in vitro study results
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2015) Gürkan, Selami; Gür, Özcan; Yüksel, Volkan; Güçlü, Orkut
    Background: In this study, we aimed to compare vasodilatation responses of arterial grafts harvested by electrocautery and without electrocautery by using the tissue bath system. Methods: Between May 2013 and June 2014, 30 patients (19 males, 11 females, mean age 60.0 +/- 8.2 years; range 47 to 77 years) who underwent elective coronary artery bypass grafting (CABG) surgery were enrolled in the study. Sixteen samples from internal thoracic artery and radial artery grafts in each group were collected. The grafts were divided into two groups: grafts harvested by electrocautery (group 1) and grafts harvested without electrocautery (group 2). Results: The vasodilatation responses of internal thoracic artery grafts were significantly reduced in group 1, compared to group 2. Although the vasodilatation responses of radial artery grafts in group 1 were lesser than in group 2, the difference was not statistically significant. Conclusion: Vessel harvesting by electrocautery may cause serious endothelial injury particularly in internal thoracic artery grafts, rather than radial artery grafts. The procedure without electrocautery may be more advantageous during the harvesting of arterial grafts in terms of preventing early graft failure.
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    Continuous renal replacement therapy after cardiac surgery in patients with acute renal failure
    (2013) Güçlü, Orkut; Yavuz, C.; Gürkan, Selami; Yüksel, V.; Demirtaş, S.; Çalışkan, Ahmet; Canbaz, Suat; Gür, Özcan
    Aim Acute renal failure is an important adverse effect of cardiopulmonary bypass that can result in high mortality or morbidity rates. It can be treated with continuous renal replacement therapy after cardiac surgery. The purpose of this study was to determine the factors associated with the mortality and incidence of acute renal failure in patients of post cardiac surgery. Methods Patients (1564) who underwent cardiac surgery between January 2007 and January 2012 and treated with continuous renal replacement therapy were included (N=40). Patients with previous renal disorders were excluded. A retrospective analysis was carried out. Results Overall, continuous renal replacement therapy was used in 40 (2.6%) patients. The mean age was 62.7±11 years. Mean duration of cardiopulmonary bypass was 166±80 min, and aorta cross-clamping time was 97±35 min. The patients' mean pretherapy creatinine level and mean creatinine level before hospital discharge were 3.3±1.1 mg/dL and 1.1±0.4 mg/dl, respectively. Thirty-day mortality was 35%. Only 6 patients required long-term renal replacement therapy. Conclusion Acute renal failure requiring hemodialysis after cardiac surgery is associated with higher mortality and morbidity and prolonged hospital stay. Early renal recovery with continuous renal replacement therapy seems to offer an evident survival benefit. Continuous renal replacement therapy may represent an important therapy and reduce mortality rates. We believe that these rates might decrease even more with detailed preoperative evaluation and meticulous postoperative care with collaborative management.
  • Küçük Resim
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    Endovasküler aortik onarımda tek merkez deneyimi: Teknik ve klinik yönlerin incelenmesi
    (2014) Demirtaş, Sinan; Tiryakioğlu, Osman; Çalışkan, Ahmet; Güçlü, Orkut; Yümün, Gündüz; Yavuz, Celal; Karahan, Oğuz
    Amaç: Bu çalışmanın amacı; cerrahisi yüksek riskli aortik patolojiye sahip hastalarda uyguladığımız Endovasküler Aortik Onarım tecrübelerimizin paylaşılması ve önceki raporlarla; gelişen mortalite, komplikasyonlar, ek girişimler açısından kıyaslanarak literatüre katkı sağlanmasıdır. Yöntemler: Retrospektif olarak endovasküler aortik onarım uygulanan hastalar değerlendirildi. Perioperatif 1 aylık mortalite, prosedür esnasındaki ek girişimler, gelişen komplikasyonlar, endoleak tipleri, uygulanan anestezi yöntemi, hastalığın tanısı, komorbid faktörleri ve demografik veriler kaydedildi. Sonuçlar literatürdeki veriler ile karşılaştırıldı. Bulgular: Abdominal endovasküler aortik onarım (EVAR) 19 hastaya uygulandı. Torasik endovasküler aortik onarım (TEVAR) 11 hastaya uygulandı. EVAR hastaları abdominal aort anevrizma tanısı ile işleme alındı. Bu hastaların 9 u rüptür nedeniyle acil olarak opere edildi. TEVAR uygulanan 8 hasta Tip 3 aort diseksiyonu, 1 hasta ise transeksiyon nedeniyle işleme alındı. Tüm vakaların 1 aylık mortalitesi % 10 ( 3 hasta) olarak bulundu. Endoleak gelişen 6 hastadan, 3 tanesi Tip1a, 2 tanesi Tip1 b ve 1 tanesi de Tip 2 idi. İki hastaya Tip1a ve 1 hastaya daTip1b endoleak nedeniyle balon anjioplasti yapıldı. Bir hastada postoperatif kontrast nefropatisine bağlı kronik böbrek yetmezliği(% 3,3) gelişti. Postoperatif dönemde hematom nedeniyle 2 (%6,7) hastada reeksplorasyon uygulandı. Sonuç: Endovasküler yöntemler aort patolojilerinde teknolojinin de ilerlemesiyle sıkça tercih edilen bir tedavi yöntemi haline gelmiştir. Bizim serimizde olduğu gibi cerrahi açıdan ciddi risk taşıyan hasta grubunda endovasküler yöntemlerin güvenle tercih edilebilecek bir alternatif olduğu kanaatindeyiz.