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    Early results of monopolar versus bipolar radiofrequency ablation for atrial fibrillation during open heart surgery
    (Cardiology Academic Press, 2013) Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, Demet; Çakır, Habib; Yüksel, Volkan; Hüseyin, Serhat; Ege, Turan
    BACKROUND: In patients with atrial fibrillation (AF) for whom open heart surgery is scheduled, it is suggested to treat AF by ablation. OBJECTIVE: To compare the efficacy of monopolar and bipolar surgical radiofrequency ablation systems in patients undergoing concomitant open heart surgery and reveal the factors affecting the conversion to sinus rhythm. METHODS: Forty-three patients (19 male and 24 female) who underwent irrigated monopolar or bipolar radiofrequency ablation for persistent AF at concomitant cardiac surgery between 2007 and 2012 were included in the study. RESULTS: Monopolar ablation was performed in 24 and bipolar ablation was performed in 19 patients. Twenty of the 24 patients who underwent monopolar radiofrequency ablation and 15 of the 19 patients in the bipolar ablation group were in sinus rhythm at the three-month follow-up. There was no statistically significant difference between the two ablation procedures on the conversion of AF to sinus rhythm. When the effect of left atrial diameter on conversion to sinus rhythm was compared, left atrial diameter >60 mm was found to have pronounced negative influence on procedural success, while left atrial diameter <60 mm had no effect. CONCLUSION: A concomitant monopolar or bipolar modified Cox maze procedure during open heart surgery is equally effective technique for AF ablation at three months of follow up. Left atrial diameters >60 mm significantly reduced the rate of conversion to sinus rhythm.
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    Management of pericardial effusion by subxiphoidal pericardiostomy in adults
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2012) Yüksel, Volkan; Hüseyin, Serhat; Okyay, Ahmet; Gürkan, Selami; Gür, Özcan; Canbaz, Suat; Duran, Enver
    Background: We aimed to assess the effectiveness of subxiphoid pericardiostomies in the treatment of patients with pericardial effusion (PE) and to discuss the etiology for this patient population. Methods: Between January 2004 and January 2011, 148 patients (77 males, 71 females; mean age 60.1 +/- 12.3 years; range 34 to 89 years;) who underwent a subxiphoid pericardiostomy and tube drainage due to a diagnosis of PE were retrospectively analyzed. Results: Echocardiography classified PE as severe in 36 patients, moderate in 68, and mild in 44. The main causes of PE were uremia and malignancy along with idiopathic and undefined tuberculous and non-tuberculous pericarditis. A perioperative myocardial injury requiring a sternotomy occurred in two patients. A histopathological examination contributed to the diagnosis in 84.3% of the patients with malignancy. The overall 30-day mortality rate was 7% (n=11). Pericardial constriction requiring a pericardiectomy developed in two patients. Conclusion: Pericardial effusion can be an effective and quick method for managing adults with subxiphoid pericardiostomy.
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    Surgical management of iatrogenic femoral artery pseudoaneurysms: A 10-year experience
    (Lithographia, 2013) Hüseyin, Serhat; Yüksel, V; Sivri, N.; Gür, Özcan; Gürkan, Selami; Canbaz, Suat; Sunar, H.
    Background: Vascular complications of cardiac catheterization have increased in line with increasing number of percutaneous interventions. Open repair is the standard method of treatment for true and false aneurysms of femoral artery. We report results of patients operated due to femoral artery pseudoaneurysm after cardiac catheterization. Methods: Data from 12,261 patients who underwent percutaneous intervention for cardiac catheterization between January 2003 and January 2013 were evaluated. Diagnosis of pseudoaneurysm was established mainly by doppler ultrasonography in patients with complaints of pain and hematoma at the intervention site. Pseudoaneurysms less than 2 cm in diameter were treated non-operatively and were followed up by regular ultrasonographic examination at the outpatient clinic. Pseudoaneurysms with a diameter of 2 cm or more underwent primary repair. All patients were followed up for one year. Results: We detected 55 (0.44%) patients with femoral artery pseudoaneurysm and 42 of them were operated. The mean age was 60.7 +/- 6.3 years. Thirty nine (94.5%) patients underwent elective surgery, three (5.5%) patients were operated on under emergency conditions. Operation was performed under local anesthesia in 32 patients, under local anesthesia and sedation in eight patients, and under general anesthesia in three patients. Location of the pseudoaneurysm was the superficial femoral artery in 29 (69%), the common femoral artery in nine (21.4%), and the deep femoral artery in four (9.6%) patients. No limb loss occurred, no patient died and no recurrence was detected during the follow up. Conclusions: Performing vascular reconstruction before the rupture of pseudoaneurysm is important in terms of morbidity and mortality. We concluded that surgical repair in pseudoaneurysms larger than 20 mm is safe and essential.
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    The effect of distension pressure on endothelial injury and vasodilatation response in saphenous vein grafts: conversion of a bypass graft to a dead pipe
    (Termedia Publishing House Ltd, 2014) Gürkan, Selami; Gür, Özcan; Yüksel, Volkan; Tastekin, Ebru; Hüseyin, Serhat; Özkaramanlı Gür, Demet; Canbaz, Suat
    Introduction: Endothelial damage caused by high pressure applied for spasm relaxation during graft preparation is one of the most plausible theories explaining early graft failure. Aim of the study: We aimed to demonstrate the extent of endothelial damage in saphenous vein grafts distended to different pressure levels by using immunohistochemical methods and in vitro tissue baths. Material and methods: Saphenous vein grafts (SVGs) of 25 patients who underwent isolated elective CABG surgery were used in this study. By using a specific mechanism, SVGs were distended to five different pressure levels for two minutes: 0 mmHg, 50 mmHg, 100 mmHg, 200 mmHg, 300 mmHg. In vitro tissue baths and immunohistochemical examinations were performed. Results: None of the grafts distended to 300 mmHg pressure were functional in the tissue bath system. The relaxation response to carbachol of SVGs distended to 0, 50, 100 and 200 mmHg was 97.87 +/- 4.47%, 98.52 +/- 3.95%, 93.78 +/- 3.64%, and 30.87 +/- 4.11%, respectively. There were no statistically significant differences in terms of relaxation responses between samples distended to 0, 50, and 100 mmHg (p = 0.490). The relaxation response of samples distended to 200 mmHg was significantly decreased (p = 0.021). The endothelia of samples distended to 0 mmHg were almost intact in CD31 staining. Endothelial cell loss occurred at all tested distension pressures at different degrees. Conclusion: In vitro and immunohistochemical studies revealed that distending an SVG used for coronary artery bypass grafting with pressures of 100 mmHg or less results in less endothelial damage and increases graft patency.
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    The impact of body mass index on mortality and morbidity in patients undergoing isolated valve surgery
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Gür, Özcan; Gürkan, Selami; Özkaramanlı Gür, Demet; Yüksel, Volkan; Hüseyin, Serhat; İşcan, Şahin; Ege, Turan
    Background: This study aims to investigate the impact of body mass index (BMI) on early mortality and morbidity in patients undergoing isolated valve surgery. Methods: Between January 2004 and December 2012, medical records of 196 patients (115 males, 81 females; mean age 62.0 years; range 28 to 81 years) who underwent isolated valve surgery in our clinic with prospective follow-up data were retrospectively analyzed. The patients were divided into three groups according to their BMI values. Group 1 consisted of patients with a BMI <25 kg/m(2), group 2 consisted of patients with a BMI of >= 25 kg/m(2) to <30 kg/m(2) and group 3 consisted of patients with a BMI of >= 30 kg/m(2). Obesity was defined as a BMI of >= 30 kg/m(2). Groups were compared in terms of morbidity parameters including bleeding, respiratory, renal, neurological and sternal complications and in-hospital mortality. Results: Increased BMI was associated with increased diabetes prevalence and use of bronchodilator. According to postoperative data, there was no significant difference in duration of extubation, postoperative renal functions, neurological complications such as stroke and transient ischemic attack, length of intensive care unit or hospital stay among three groups. Obese patients in group 3 had significantly higher rates of respiratory complications including re-intubation (p=0.011) and postoperative bronchodilator need (p=0.034), sternal dehiscence and sternal infections (p=0.023) and in-hospital mortality (p=0.021). The bleeding complications were significantly higher in group 1 (p=0.004). Conclusion: Our study results suggest that obesity results in increased 30-day mortality and several morbidity parameters such as respiratory and sternal complications in patients undergoing isolated valve surgery.
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    Unexpected etiology in pericardial effusion: Malignant fibrous histiocytoma: Case report
    (2013) Hüseyin, Serhat; Yüksel, V.; Gürkan, Selami; Gür, Özcan; Ege, Turan
    Although malignant fibrous histiocytoma is the most widely seen malignant soft tis sue tumor in adults, mediastinal localizations are uncommon. In this report, we aimed to present a patient admitted to hospital with complaints of hypotension, vertigo, arrhythmia and operated under emergency conditions for severe paericardial effusion leading to right atrial collapse and di agnosed as malignant fibrous histiocytoma. Copyright © 2013 by Türkiye Klinik leri.