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Öğe Combined treatment of both arterial and deep venous thrombosis in a young adult with antiphospholipid syndrome: case report(2014) Gürkan, Selami; Gür, Özcan; Chousein-Hüseyin, Serchat-Serhat; Yüksel, Volkan; Canbaz, SuatAntifosfolipid sendromu değişik tromboembolik olaylara sebep olabilen, otoimmün hiperkoagülabilite sendromudur. Olguların %35inde pulmoner emboli ve infarktla komplike olabilen derin ven trombozu görülebilir. Hastalığın klinik görünümleri arasında; venöz ve arteriyel trombozlarla birlikte emboliler, multiorgan iskemisi ve infarktına neden olabilen küçük ve yaygın büyük damar trombozları, prematür koroner arter hastalığı, strok ve düşükler sayılabilir. Bu yazıda 25 yaşındaki genç erkek hastada görülen arteriyel ve venöz trombozu ile cerrahi ve medikal tedavi birlikteliğini sundukÖğe 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, OrkutBackground: 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.Öğe 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, TuranBACKROUND: 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.Öğe Elektif vasküler cerrahi sonrası mortalite: Konuşmadığımız gerçekler(2014) Chousein-Hüseyin, Serchat-Serhat; Yüksel, Volkan; Halıcı, Ümit; Sağıroğlu, Gönül; Gürkan, Selami; Gür, Özcan; Sunar, HasanAmaç: Periferik arter hastalığı ilerleyici ve tıkayıcı nitelikte sistemik bir hastalıktır ve cerrahi sonrasında 30 günlük mortalite oranı %2-8,5 arasında değişmektir. Bu çalışmamızda, kliniğimizdeki elektif vasküler cerrahi sonrası mortalite nedenlerini araştırmayı hedefledik. Gereç ve Yöntemler: Kliniğimizde Ocak 2006 ile Aralık 2012 tarihleri arasında periferik arter hastalığı nedeniyle elektif vasküler cerrahi uygulanan toplam 864 hasta çalışmaya dahil edildi. On sekiz yaşın altındaki bireyler, acil müdahale edilen hastalar ve travma nedeniyle vasküler cerrahi uygulanan hastalar çalışmaya dahil edilmedi. Hastaların preoperatif demografik özellikleri, operatif risk faktörleri, eşlik eden komorbid sistemik hastalıkları ile, yapılan operasyonlar, postoperatif yoğun bakımda kalış süreleri ve mortaliteye sebep olan faktörler incelenip değerlendirildi. Bulgular: Opere edilen 864 hastanın 20sinde (%2,3) mortalite gelişti. Mortalite gözlenen 20 hastanın 19u erkek (%95), 1i kadın (%5) idi. Hastaların tamamı elektif şartlarda genel anestezi altında opere edilmişti. Mortalite sebeplerinin; hastaların 7sinde (%35) kardiyak nedenlere (düşük kardiyak debi sendromu, aritmi, postoperatif miyokard enfarktüsü), 3ünde (%15) multipl organ yetmezliğine, 3ünde (%15) akciğer nedenlerine (pnömoni, ventilatörden ayrılamama), 3ünde (%15) gastrointestinal sistem komplikasyonlarına (mezenter iskemi, gastrointestinal kanama), 1inde (%5) sepsise, 1inde (%5) dissemine intravasküler koagülasyona (DİK), 1inde (%5) nörolojik problemlere (postoperatif serebrovasküler olay) ve 1inde (%5) peroperatif gelişen malign hipertermiye bağlı olduğu görüldü. Sonuç: Elektif vasküler cerrahi uygulanacak hastalarda preoperatif iyi bir kardiyak ve diğer sistemlere ait değerlendirmenin yapılması ileri derecede önem arz etmekte olup, alınacak tedbirler ile özellikle kardiyovasküler risk faktörlerini en aza indirerek, mortalite ve morbiditeyi önemli ölçüde azaltılabileceği kanaatindeyiz.Öğe 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, EnverBackground: 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.Öğe 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, SuatIntroduction: 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.Öğe 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, TuranBackground: 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.
