Browsing by Author "Aykac, Mehmet Coskun"

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Comparison of Blood Cardioplegia and Del Nido Cardioplegia Use in Isolated Vsd Patients
(Discovery Publication, 2018) Ozbek, Baburhan; Gur, Ali Kemal; Aykac, Mehmet Coskun; Eker, Esra
Objective: Ventricular septal defect (VSD) is the most common pathology among congenital heart diseases. Surgical closure, transcatheter closure or medical follow-up are among the treatment strategies. Surgical closure of VSD can now be safely performed with low morbidity and mortality. In this study, we aimed to compare the efficacy of blood cardioplegia and del Nido cardioplegia during VSD operation. Material and Method: In our Pediatric Cardiovascular Surgery Clinic, we retrospectively evaluated 186 patients, between 6 weeks and 18 years of age, who underwent operation due to isolated VSD between September 2013 and December 2017. Patients were divided into two groups as Group 1 (n = 108 using blood cardioplegia) and Group 2 (n = 78 using del Nido cardioplegia). Pre-operative data, peri-operative data and postoperative data of patients were retrospectively recorded and reviewed in detail. Findings: 153 patients (82.2%) were under 5 years old, 24 (12.9%) were between 5 and 10 years old, and 9 (4.8%) were between 10 and 20 years of age. 112 (60.2%) of the patients were male and 74 (39.8%) were female. The mean age of the patients was 3.8 +/- 2.08 in Group 1 and 4.2 +/- 2.13 in Group 2. There was no statistically significant difference in preoperative demographic data between Group 1 and Group 2 patients (p> 0.05). The duration of cardiopulmonary bypass (CPB), duration of intubation, intensive care unit stay and discharge time were found to be statistically significant when compared with Group 1 (p < 0.05). Result: Congenital heart disease cases can have a long operation time. In the light of our findings, we recommend the use of del Nido cardioplegia, which is administered a single-time and reduces inotropic need and duration of operation as well as significantly reduce extubation and discharge times, instead of blood cardioplegia which is given every twenty minutes. It can be said that del Nido cardioplegia can be safely used in the cases of congenital heart surgery, although it is difficult to give a definitive judgment due to the inadequacy of our case count.
Delta Hepatitis-Related Thyroid Disease: a Unique Phenomenon
(Termedia Publishing House Ltd, 2015) Suvak, Burak; Dulger, Ahmet Cumhur; Aykac, Mehmet Coskun; Gonullu, Hayriye; Gonullu, Edip
Introduction: Hepatitis delta virus (HDV) infection is a serious health problem worldwide. Thyroid disturbances represent a major limitation to the efficacy of interferon treatment targeting chronic HDV (C-HDV) infection. Moreover, pre-treatment thyroid diseases may be influenced by interferon therapy. Despite this, the characteristic features of the thyroid diseases in C-HDV patients remain poorly characterised. Aim: To determine the prevalence of thyroid diseases and evaluate the impact of delta hepatitis on thyroid function tests. Material and methods: We retrospectively reviewed the charts of 127 hepatitis C virus (HCV)-negative adults, treatment-naive outpatients with C-HDV, between July 2013 and July 2014. Thyroid-stimulating hormone (TSH) and thyroid antibodies (TAbs) including anti-thyroid peroxidase antibodies (anti-TPO), liver transaminases, and other routine laboratory tests were conducted during the study period. Results: A total of 127 C-HDV patients (female 52.9%, mean age 54.5 +/- 8.01 years) were enrolled. The rate of hypothyroidism, defined as a TSH level above 10 IU/l, was 4.7%. No patient had hyperthyroidism. Both elevated levels of liver transaminases and HDV ribonucleic acid (HDV-RNA) were positively correlated with high levels of thyroid autoantibodies. Conclusions: The rate of hypothyroidism is higher than the rate of hyperthyroidism at baseline. Most remarkably, for the first time we discovered a correlation between disturbed thyroid autoantibodies and elevated liver transaminases as well as high HDV-RNA levels even in euthyroid delta hepatitis patients. But in order to have an adequate understanding of such correlations, further studies are needed.
Does Heated Erythrocyte Suspension Transfusion With Medical Devices Containing Phthalates Increase Dehp and Mehp Levels
(Wiley, 2021) Gonullu, Edip; Bilvanisi, Sevdegul; Tasdogen, Aydin; Gonullu, Hayriye; Erkin, Yuksel; Kume, Tuncay; Aykac, Mehmet Coskun
Aims It is commonly known that stored blood and blood products are heated before transfusion to prevent hypothermia, which leads to increased di-(2-ethylhexyl) phthalate (DEHP) content leaching into the blood and blood products and thereby causes greater conversion of DEHP to mono (2-ethylhexyl) phthalate (MEHP). However, there has been no study in the literature reporting on the amount of toxic phthalates in blood following the erythrocyte suspension (ES) transfused via warming. In this study, we aimed to investigate the DEHP and MEHP content in blood following the heated ES transfusions administered by DEHP-containing and DEHP-free infusion sets. Methods The study included 30 patients that were randomly divided into two groups with 15 patients each: group I underwent ES transfusion via DEHP-containing infusion sets warmed with blood-fluid warmers, and group II underwent ES transfusion via DEHP-free infusion sets warmed with blood-fluid warmers. DEHP and MEHP levels were measured both before and after transfusion. Results DEHP-free infusion sets led to no increase in the phthalate content, whereas DEHP-containing infusion sets significantly increased the DEHP and MEHP, where the DEHP level increased almost four times (P = .001). Conclusion DEHP-containing products lead to toxicity. Therefore, using DEHP-free medical devices may prevent toxicity in patients undergoing ES transfusion.
The Effects of the Usage of Blood and Blood Products in Open Heart Surgery Patients and the Risk of Postoperative Atrial Fibrillation Development
(Discovery Publication, 2018) Gur, Ali Kemal; Tekeli, Arzu Esen; Eker, Esra; Aykac, Mehmet Coskun
Background: The current study explains the relationship between blood and blood-products that are used during surgery and AF. Material and Methods: A total of 260 patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2015 and March 2017 were included in the study, retrospectively. The study subjects were divided into two groups; patients whom we used blood products during surgery (Group I) and patients whom we didn't use blood products during surgery (Group II). In Group I there were 140 patients (54 female, 86 male), in Group 2 there were 120 patients (45 female, 75 male). AF rates, perioperative and postoperative blood usage rates and preoperative demographic characteristics were recorded and studied in both groups. Results: AF developed in 95 (36%) of 260 patients who underwent isolated coronary bypass surgery. AF developed in 64 (45%) patients in group I and 31 (25%) in group II. The incidence of AF was found to be statistically significantly lower in the group which we the blood products weren't used (p> 0,05). There was no significant difference between the groups in terms of smoking habits, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and hypertension (HT). The mean age was 63.2 +/- 9.2 years in Group I and 60.5 +/- 8.3 years in Group II. Aortic cross clamping (ACK) duration in patients with cardiopulmonary bypass was 65.2 +/- 33.1 minutes in Group I, In the Group 2 mean duration was 59.7 +/- 25.4 minutes (p < 0,05). The mean number of distal anastomoses was 3.1 +/- 2.3 in Group I and 3.5 +/- 2.7 in Group II (p < 0,05). 1 bag of blood and blood products were given to 75 patients (53.5%), 2 bags to 38 patients (27.1%) and 3 bags were given to 27 patients (19.2%). The mean duration of hospitalization in intensive care unit was 3.2 +/- 1.6 days in Group I and 2.1 +/- 1.1 days in Group II. No mortal cases within the first month were included in the study. Conclusion: The incidence of AF was significantly lower in coronary bypass operations without the usage of blood and blood products during and after the operation. We conclude that limiting the usage of blood and blood products will result in a significant reduction in the incidence of AF.
Should Plication or Graft Be Used in Pulmonary Artery Aneurysm Operations
(Discovery Publication, 2018) Ozbek, Baburhan; Gur, Ali Kemal; Aykac, Mehmet Coskun; Yargi, Mahmut
Objective: Pulmonary artery aneurysms (PAA) are rare diseases generally diagnosed coincidentally. Although most of the PAA patients are asymptomatic, they can be symptomatic due to complications such as rupture, pulmonary valve leakage, thromboemboli, dissection and pressure on coronary arteries and pulmonary valve. Our aim in this study was to compare plication and graft usage techniques in PAA operations. Material and Method: A total of 11 patients who had elective PAA operation between January 1, 2010 and December 31, 2018 in our clinic and had registered demographical information were retrospectively examined. Patients included in the study were separated into two groups as those who had plication in PAA (Group 1) and those who had tube graft change in PAA (Group 2). There were six patients in Group 1 (2 F, 4 M) and five patients (2 F, 3 M) in Group 2. Preoperative and postoperative data of the patients in both groups were registered and examined in detail. Findings: Among the 11 patients who had surgical repair due to PAA, seven were male and four were female. Although the ages of the patients changed between 38 and 65, the average age was 53.4 years. There was no significant difference in diabetes mellitus, hypertension, coronary artery disease among the groups. Chronic obstructive pulmonary disease (COPD) was observed more in Group 1. Operations were made under cardiopulmonary bypass. Aortic cross clamp duration (ACC) was 96 +/- 18 minutes in Group 1 and 105 +/- 22 minutes in Group 2 (p>0.05). Average intensive care unit hospitalization duration of the patients was 2.5 +/- 1.5days in Group 1 and 3.4 +/- 1.5 days in Group 2 (p<0.05) but no statistically significant difference was found among the average hospitalization durations of the patients (p>0,05). Result: Although observed frequently, PAA can cause mortality especially due to causes such as rupture and dissection. Surgical intervention is required in patients with PAA over 5,5 cm. Although different views are available in literature, in our study, we detected tube graft usage to be more effective in surgical treatment. As there is a change of aneurysm reformation in postoperative followups of the patients who had plication especially, we suggest graft usage in PAA surgical treatment.
Surgical Treatment of Cardiac Myxomas: a 23-Case Experience
(Forum Multimedia Publishing, Llc, 2018) Gur, Ali Kemal; Aykac, Mehmet Coskun
Objective: Although seen rarely compared to all tumors, cardiac tumors are tumors which may have a mortal course with possible complications. The most common cardiac tumor in adults is myxoma with its benign character. The results of cardiac tumors resected with open cardiac surgery in our center are reported in this study. Materials and Methods: Twenty-three cardiac tumor patients electively operated on in our clinic between January 2010 and August 2017 were retrospectively included in the study. Information of the patients participating in the study were registered. The patients were between 25 and 67 years of age, and 18 were female (72.3%), and 5 were male (21.7%). The average age of the patients was 42.1 +/- 8.9 years. Echocardiography was used for diagnosis in all patients. There was no common complaint for the patients, with the complaints changing according to tumor location. All patients were operated on by means of cardiopulmonary bypass with aortic cross-clamp and bicaval cannulation. Preoperative demographical characteristics and perioperative and postoperative data were registered for the patients and were evaluated statistically. Results: Nineteen of the tumors (82.6%) were in the left atrium, and 4 were (17.4%) in the right atrium. Diameter of the tumors changed between 2.5 x 1.5 and 8.5 x 6.5 cm. The tumoral structure was resected together with the solid tissue located in its root in all patients operated on. Pericardial patch was used for 11 (47.8%), and primary closure was used for 12 (51.2%) of the defects. Early and late mortality was not observed in any patient. Conclusion: To prevent possible complications of cardiac myxomas, they need to be resected together with the surrounding healthy tissue as soon as possible after the diagnosis. Cardiac myxomas can be operated on with a tolerable operation risk. Echocardiography should be made annually for any possible relapse after operation.
When To Remove Drains After Coronary Bypass Surgery
(Discovery Publication, 2018) Gur, Ali Kemal; Eker, Esra; Tekeli, Arzu Esen; Aykac, Mehmet Coskun
Background: Mediastinal and thoracic drains after open heart surgery are a vital preventive measure against postoperative cardiac tamponade. In this study, we investigated when to remove mediastinal and thoracal drains in patients who underwent isolated coronary bypass surgery. Material and Methods: A total of 446 patients who underwent elective isolated coronary artery bypass grafting (CABG) in our clinic between January 2015 and March 2017 were enrolled prospectively. Patients were divided into two groups: Group I (the last 24-hour drainage follow-up was under 150 ml) and Group II (last 24 hours drainage follow-up was under 50 ml). There were 210 patients (95 female, 115 male) in Group I and 236 patients (112 female, 124 male) in Group II. Postoperative Tamponade and pleural effusion rates, perioperative and postoperative blood usage rates, and preoperative demographic characteristics were recorded evaluated statistically. Results: The average age of the patients included in the study was 59,5 +/- 6,2, consisting of 239 male and 207 female patients. There were 210 patients (95 F, 115 M) in group I, 236 patients (112 F, 124 M) in group II. The mean amount of drainage; in Group I: 582 +/- 123 ml, in Group II: 614 +/- 205 ml. The average time of drain removal; Group I: 2.3 +/- 0.5 days, Group II: 4.1 +/- 0.3 days. Development rate of cardiac tamponade that required surgery on the first postoperative day; Group I: 5 (2.3%) and Group II: 3 (1.2%) respectively (p<0.05). Thoracentesis was required due to pleural effusion in 11 (5.2%) patients in group I and 6 (2.5%) patients in group II (p<0.05). The overall average age of the patients was 59.5 +/- 6.2 and consisted of 239 male and 207 female patients. Conclusion: It can be suggested that drains should not be removed until the drainage amount of the mediastinal and thoracal drains is reduced to 50 ml / day to further reduce the morbidity after isolated coronary bypass surgery.