Kardiyovasküler tıp e dergisi/e journal of cardiovascular medicine, Dec 9, 2019
Atrial fibrillation (AF) is the most common cardiac arrhythmia with the rate of 1-2% in general p... more Atrial fibrillation (AF) is the most common cardiac arrhythmia with the rate of 1-2% in general population. It is characterized by the absence of coordinated pulses in the atrium and micro-re-entry. Increasing age, coronary artery disease and valve pathologies are the risk factors for the development of AF. It can be seen both non-cardiac surgery (10-20%) and cardiac surgery (20-40%). This disease is expected to double in the next 25 years. Despite current drug and electrophysiological treatments, death and functional limitations related to AF are still common. In this paper we present the current status of simultaneous surgical ablation for AF in the light of current literature.
Transplant patients are the challenging subgroup of patients due to the increased morbidity assoc... more Transplant patients are the challenging subgroup of patients due to the increased morbidity associated with their immunosuppressive state. The number of transplant patients who undergo open heart surgery continues to increase as the knowledge gained in the treatment of these patients increases. We present a renal transplant patient who underwent open heart surgery where we share our experience in the management and the treatment of these patients.
Transplant patients are the challenging subgroup of patients due to the increased morbidity assoc... more Transplant patients are the challenging subgroup of patients due to the increased morbidity associated with their immunosuppressive state. The number of transplant patients who undergo open heart surgery continues to increase as the knowledge gained in the treatment of these patients increases. We present a renal transplant patient who underwent open heart surgery where we share our experience in the management and the treatment of these patients.
Background Advancement in the field of cardiovascular surgery has emerged with various minimally ... more Background Advancement in the field of cardiovascular surgery has emerged with various minimally invasive approaches for the treatment of multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. This study describes our routine technical approach and clinical experience of minimally invasive coronary artery bypass via left anterior minithoracotomy for the treatment of patients with multivessel coronary lesions. Methods Our experience includes 100 consecutive patients who were operated between July 2020 and April 2021. The left internal thoracic artery was harvested in all patients. Radial arterial grafts and saphenous vein grafts were harvested endoscopically. Patients were operated either under cardiopulmonary bypass (CPB) with blood cardioplegia through left anterior minithoracotomy of 5 to 7 cm or off-pump via left anterolateral minithoracotomy. Results We had single mortality (1%), no early postoperative myocardial in...
For many years up to date coronary artery bypass surgery has been performed via sternotomy as a g... more For many years up to date coronary artery bypass surgery has been performed via sternotomy as a gold standard approach. However recently there has been alternative approaches for coronary artery bypass grafting in minimal invasive ways to reduce complications associated with sternotomy such as sternal wound infections, impared pulmonary functions and cosmetic related problems. Most of these minimal invasive procedures have been associated with long learning curve, high costs and sophiscated instruments used during surgery. Minimal invasive coronary artery bypass grafting via left anterior mini-thoracotomy is equally effective as a gold standard sternotomy with the same principles of suturing techniques and provides a great comfort in many aspects as sternotomy. It is safe and does not require sophiscated tools which require long learning curve and high expanses. This type of surgery requires the use of novel strategies, especially in patients who hold the highest potential for postoperative morbidity. In this paper, we will highlight the strategies and pitfalls associated with minimally invasive total coronary revascularization via left anterior minithoracotomy.
A 54‐year‐old male was admitted to our hospital with a prolonged dypsnea, orthopnoea, and chest p... more A 54‐year‐old male was admitted to our hospital with a prolonged dypsnea, orthopnoea, and chest pain that has lasted for almost 2 weeks. Physical examination revealed symptoms of heart failure. Transthoracic echocardiography revealed a ventricular septal defect located at the apical segment of the interventricular septum, mild mitral regurgitation, and hypokinesia of the apex of the left ventricle. Coronary angiography showed a critical proximal lesion of the left anterior descending artery. He was diagnosed with postmyocardial infarction ventricular septal defect. Our patient underwent minimal invasive coronary artery bypass and ventricular septal defect repair via left anterior minithoracotomy. Postoperative period was uneventful and our patient was released on a postoperative Day 7. Postoperative transthoracic echocardiography revealed no residue of repaired ventricular septal defect with improved left ventricular functions.
Myocardial revascularization guidelines help cardiologist and cardiovascular surgeons to determin... more Myocardial revascularization guidelines help cardiologist and cardiovascular surgeons to determine the best treatment option for revascularization of the diseased coronary arteries. However, in daily practice compliance to guidelines are generally insufficient. Cardiologist might prefer ad hoc coronary stent implantation without discussing the patients with the surgeons. Creating a "heart team" and activating it, during the decision-making period is recommended in the guidelines. In addition, the importance of patient participation is emphasized in determining the treatment strategy. In this article we aimed to investigate the compliance of the cardiologist and cardiovascular surgeons to the guidelines, and to determine the factors that interfere with the application in daily practice.
Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgic... more Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgical approach, in patients undergoing coronary artery bypass grafting (CABG), in left anterior descending arteries (LAD) with multiple failed overlapping stents. We retrospectively reviewed the data of six patients undergoing CABG with multiple failed overlapping stents in the LAD. All patients were operated on electively. After removal of the stents with an open endarterectomy, the long segmental arteriotomy of the LAD was reconstructed with a saphenous vein patch. Afterwards the left internal mammary artery was anastomosed to the vein patch. The mean age was 61.5 ± 7.9 years. Five patients (83.3%) were in Canadian Cardiovascular Society Class III or IV. Four patients (66.6%) had suffered a remote myocardial infarction (>1 month). The average hospital stay was 6.5 ± 1.1 days. Postoperative electrocardiograms showed no specific changes and no myocardial enzyme elevations were noted. Early postoperative angiography showed that all grafts including the endarterectomized LAD were patent. There was no mortality within the 30 days. Patients' mean follow-up time was 35.6 ± 36.7 months. CABG with open stent endarterectomy is a valuable alternative option for patients with "full-metal jacket" diseased LAD that are not graftable using standard surgical techniques.
Background: This study was undertaken to determine whether methylprednisolone could improve myoca... more Background: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB).Methods: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. Results: A comparison of patients between both groups revealed significantly high levels of I...
Objective: In this study, the efficacy of left ventricular (LV) endoaneurysmorrhaphy and cryoabla... more Objective: In this study, the efficacy of left ventricular (LV) endoaneurysmorrhaphy and cryoablation without intraoperative electrophysiologic mapping was evaluated in patients with postinfarction LV aneurysm and sustained ventricular tachycardia (VT). Methods: A prospective study was performed on all patients operated with malignant VT in the presence of a resectable LV aneurysm between July 1990 and February 2001. Results: The study included 31 patients, 20 men and 11 women, with a mean age of 65.5 years (47-84). Monomorphic, polymorphic VT or ventricular fibrillation was present in all patients prospectively, and VT was incessant in 11. Twenty-six patients had an anterior, four patients had an inferior and one patient a posterolateral myocardial wall infarction. All patients had a well-limited ventricular aneurysm. Ten patients had three, eight patients two and 13 patients had single vessel coronary artery disease. Mean preoperative ejection fraction was 34.8 ^14.5% (8-62) and mean end-diastolic volume index was 141.5 ^51.8 ml/m 2 (57-288). Six patients had mitral regurgitation grade III or IV. All patients underwent extensive cryoablation at the transition zone of scar and viable tissue and LV remodelling with prosthetic patch in 26 patients. Associated procedures were CABG in 19 patients (61%) and mitral valve reconstruction in six patients (19%). Postoperative electrophysiologic study (EPS) revealed freedom from VT induction in 25 patients and inducible VT in five patients. One patient had inducible polymorphic VT. Five patients received an implantable cardioverter defibrillator (ICD) and three patients had a permanent pacemaker implanted. After a mean follow-up of 30 ^27 months (6-132) there was one arrhythmia-related death. There was one early hospital readmission for clinical VT and no need for late ICD implantation. Conclusions: In patients suffering from ventricular arrhythmias in the presence of a complicated postinfarction LV aneurysm, combined 'blind' cryoablation and endoaneurysmorrhaphy offers excellent arrhythmia control and clinical and haemodynamic outcome.
Bu çalışmada sıçanlarda eş zamanlı olarak uygulanan kalp ve cilt allogrefti transplantasyonun kal... more Bu çalışmada sıçanlarda eş zamanlı olarak uygulanan kalp ve cilt allogrefti transplantasyonun kalp allogreft sürvisine etkileri araştırıldı. Kalp allogrefti ve cilt allogrefti uygulanan grup (grup I), kalp allogrefti ve cilt allogrefti uygulanan grup (grup II) ile karşılaştırıldı. Kalp allogreft ...
ortic dissection is a catastrophic event especially in the acute form. Survival after acute aorti... more ortic dissection is a catastrophic event especially in the acute form. Survival after acute aortic dissection with cerebral malperfusion is a rare condition. Optimal treatment for acute type A aortic dissec-
Kardiyovasküler tıp e dergisi/e journal of cardiovascular medicine, Dec 9, 2019
Atrial fibrillation (AF) is the most common cardiac arrhythmia with the rate of 1-2% in general p... more Atrial fibrillation (AF) is the most common cardiac arrhythmia with the rate of 1-2% in general population. It is characterized by the absence of coordinated pulses in the atrium and micro-re-entry. Increasing age, coronary artery disease and valve pathologies are the risk factors for the development of AF. It can be seen both non-cardiac surgery (10-20%) and cardiac surgery (20-40%). This disease is expected to double in the next 25 years. Despite current drug and electrophysiological treatments, death and functional limitations related to AF are still common. In this paper we present the current status of simultaneous surgical ablation for AF in the light of current literature.
Transplant patients are the challenging subgroup of patients due to the increased morbidity assoc... more Transplant patients are the challenging subgroup of patients due to the increased morbidity associated with their immunosuppressive state. The number of transplant patients who undergo open heart surgery continues to increase as the knowledge gained in the treatment of these patients increases. We present a renal transplant patient who underwent open heart surgery where we share our experience in the management and the treatment of these patients.
Transplant patients are the challenging subgroup of patients due to the increased morbidity assoc... more Transplant patients are the challenging subgroup of patients due to the increased morbidity associated with their immunosuppressive state. The number of transplant patients who undergo open heart surgery continues to increase as the knowledge gained in the treatment of these patients increases. We present a renal transplant patient who underwent open heart surgery where we share our experience in the management and the treatment of these patients.
Background Advancement in the field of cardiovascular surgery has emerged with various minimally ... more Background Advancement in the field of cardiovascular surgery has emerged with various minimally invasive approaches for the treatment of multivessel coronary disease to improve outcomes and minimize the burden associated with conventional cardiac surgery. This study describes our routine technical approach and clinical experience of minimally invasive coronary artery bypass via left anterior minithoracotomy for the treatment of patients with multivessel coronary lesions. Methods Our experience includes 100 consecutive patients who were operated between July 2020 and April 2021. The left internal thoracic artery was harvested in all patients. Radial arterial grafts and saphenous vein grafts were harvested endoscopically. Patients were operated either under cardiopulmonary bypass (CPB) with blood cardioplegia through left anterior minithoracotomy of 5 to 7 cm or off-pump via left anterolateral minithoracotomy. Results We had single mortality (1%), no early postoperative myocardial in...
For many years up to date coronary artery bypass surgery has been performed via sternotomy as a g... more For many years up to date coronary artery bypass surgery has been performed via sternotomy as a gold standard approach. However recently there has been alternative approaches for coronary artery bypass grafting in minimal invasive ways to reduce complications associated with sternotomy such as sternal wound infections, impared pulmonary functions and cosmetic related problems. Most of these minimal invasive procedures have been associated with long learning curve, high costs and sophiscated instruments used during surgery. Minimal invasive coronary artery bypass grafting via left anterior mini-thoracotomy is equally effective as a gold standard sternotomy with the same principles of suturing techniques and provides a great comfort in many aspects as sternotomy. It is safe and does not require sophiscated tools which require long learning curve and high expanses. This type of surgery requires the use of novel strategies, especially in patients who hold the highest potential for postoperative morbidity. In this paper, we will highlight the strategies and pitfalls associated with minimally invasive total coronary revascularization via left anterior minithoracotomy.
A 54‐year‐old male was admitted to our hospital with a prolonged dypsnea, orthopnoea, and chest p... more A 54‐year‐old male was admitted to our hospital with a prolonged dypsnea, orthopnoea, and chest pain that has lasted for almost 2 weeks. Physical examination revealed symptoms of heart failure. Transthoracic echocardiography revealed a ventricular septal defect located at the apical segment of the interventricular septum, mild mitral regurgitation, and hypokinesia of the apex of the left ventricle. Coronary angiography showed a critical proximal lesion of the left anterior descending artery. He was diagnosed with postmyocardial infarction ventricular septal defect. Our patient underwent minimal invasive coronary artery bypass and ventricular septal defect repair via left anterior minithoracotomy. Postoperative period was uneventful and our patient was released on a postoperative Day 7. Postoperative transthoracic echocardiography revealed no residue of repaired ventricular septal defect with improved left ventricular functions.
Myocardial revascularization guidelines help cardiologist and cardiovascular surgeons to determin... more Myocardial revascularization guidelines help cardiologist and cardiovascular surgeons to determine the best treatment option for revascularization of the diseased coronary arteries. However, in daily practice compliance to guidelines are generally insufficient. Cardiologist might prefer ad hoc coronary stent implantation without discussing the patients with the surgeons. Creating a "heart team" and activating it, during the decision-making period is recommended in the guidelines. In addition, the importance of patient participation is emphasized in determining the treatment strategy. In this article we aimed to investigate the compliance of the cardiologist and cardiovascular surgeons to the guidelines, and to determine the factors that interfere with the application in daily practice.
Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgic... more Multiple stents make standard coronary artery bypass techniques difficult. We describe our surgical approach, in patients undergoing coronary artery bypass grafting (CABG), in left anterior descending arteries (LAD) with multiple failed overlapping stents. We retrospectively reviewed the data of six patients undergoing CABG with multiple failed overlapping stents in the LAD. All patients were operated on electively. After removal of the stents with an open endarterectomy, the long segmental arteriotomy of the LAD was reconstructed with a saphenous vein patch. Afterwards the left internal mammary artery was anastomosed to the vein patch. The mean age was 61.5 ± 7.9 years. Five patients (83.3%) were in Canadian Cardiovascular Society Class III or IV. Four patients (66.6%) had suffered a remote myocardial infarction (>1 month). The average hospital stay was 6.5 ± 1.1 days. Postoperative electrocardiograms showed no specific changes and no myocardial enzyme elevations were noted. Early postoperative angiography showed that all grafts including the endarterectomized LAD were patent. There was no mortality within the 30 days. Patients' mean follow-up time was 35.6 ± 36.7 months. CABG with open stent endarterectomy is a valuable alternative option for patients with "full-metal jacket" diseased LAD that are not graftable using standard surgical techniques.
Background: This study was undertaken to determine whether methylprednisolone could improve myoca... more Background: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB).Methods: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. Results: A comparison of patients between both groups revealed significantly high levels of I...
Objective: In this study, the efficacy of left ventricular (LV) endoaneurysmorrhaphy and cryoabla... more Objective: In this study, the efficacy of left ventricular (LV) endoaneurysmorrhaphy and cryoablation without intraoperative electrophysiologic mapping was evaluated in patients with postinfarction LV aneurysm and sustained ventricular tachycardia (VT). Methods: A prospective study was performed on all patients operated with malignant VT in the presence of a resectable LV aneurysm between July 1990 and February 2001. Results: The study included 31 patients, 20 men and 11 women, with a mean age of 65.5 years (47-84). Monomorphic, polymorphic VT or ventricular fibrillation was present in all patients prospectively, and VT was incessant in 11. Twenty-six patients had an anterior, four patients had an inferior and one patient a posterolateral myocardial wall infarction. All patients had a well-limited ventricular aneurysm. Ten patients had three, eight patients two and 13 patients had single vessel coronary artery disease. Mean preoperative ejection fraction was 34.8 ^14.5% (8-62) and mean end-diastolic volume index was 141.5 ^51.8 ml/m 2 (57-288). Six patients had mitral regurgitation grade III or IV. All patients underwent extensive cryoablation at the transition zone of scar and viable tissue and LV remodelling with prosthetic patch in 26 patients. Associated procedures were CABG in 19 patients (61%) and mitral valve reconstruction in six patients (19%). Postoperative electrophysiologic study (EPS) revealed freedom from VT induction in 25 patients and inducible VT in five patients. One patient had inducible polymorphic VT. Five patients received an implantable cardioverter defibrillator (ICD) and three patients had a permanent pacemaker implanted. After a mean follow-up of 30 ^27 months (6-132) there was one arrhythmia-related death. There was one early hospital readmission for clinical VT and no need for late ICD implantation. Conclusions: In patients suffering from ventricular arrhythmias in the presence of a complicated postinfarction LV aneurysm, combined 'blind' cryoablation and endoaneurysmorrhaphy offers excellent arrhythmia control and clinical and haemodynamic outcome.
Bu çalışmada sıçanlarda eş zamanlı olarak uygulanan kalp ve cilt allogrefti transplantasyonun kal... more Bu çalışmada sıçanlarda eş zamanlı olarak uygulanan kalp ve cilt allogrefti transplantasyonun kalp allogreft sürvisine etkileri araştırıldı. Kalp allogrefti ve cilt allogrefti uygulanan grup (grup I), kalp allogrefti ve cilt allogrefti uygulanan grup (grup II) ile karşılaştırıldı. Kalp allogreft ...
ortic dissection is a catastrophic event especially in the acute form. Survival after acute aorti... more ortic dissection is a catastrophic event especially in the acute form. Survival after acute aortic dissection with cerebral malperfusion is a rare condition. Optimal treatment for acute type A aortic dissec-
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