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Aykut G, Ulugöl H, Aksu U, Akin S, Karabulut H, Alhan C, Toraman F, Ince C. Microcirculatory Response to Blood vs. Crystalloid Cardioplegia During Coronary Artery Bypass Grafting With Cardiopulmonary Bypass. Front Med (Lausanne) 2022; 8:736214. [PMID: 35096853 PMCID: PMC8792788 DOI: 10.3389/fmed.2021.736214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Blood cardioplegia attenuates cardiopulmonary bypass (CPB)-induced systemic inflammatory response in patients undergoing cardiac surgery, which may favorably influence the microvascular system in this cohort. The aim of this study was to investigate whether blood cardioplegia would offer advantages over crystalloid cardioplegia in the preservation of microcirculation in patients undergoing coronary artery bypass grafting (CABG) with CPB. Methods: In this prospective observational cohort study, 20 patients who received crystalloid (n = 10) or blood cardioplegia (n = 10) were analyzed. The microcirculatory measurements were obtained sublingually using incident dark-field imaging at five time points ranging from the induction of anesthesia (T0) to discontinuation of CPB (T5). Results: In the both crystalloid [crystalloid cardioplegia group (CCG)] and blood cardioplegia [blood cardioplegia group (BCG)] groups, perfused vessel density (PVD), total vessel density (TVD), and proportion of perfused vessels (PPV) were reduced after the beginning of CPB. The observed reduction in microcirculatory parameters during CPB was only restored in patients who received blood cardioplegia and increased to baseline levels as demonstrated by the percentage changes from T0 to T5 (%Δ)T0−T5 in all the functional microcirculatory parameters [%ΔTVDT0−T5(CCG): −10.86 ± 2.323 vs. %ΔTVDT0−T5(BCG): 0.0804 ± 1.107, p < 0.001; %ΔPVDT0−T5(CCG): −12.91 ± 2.884 vs. %ΔPVDT0−T5(BCG): 1.528 ± 1.144, p < 0.001; %ΔPPVT0−T5(CCG): −2.345 ± 1.049 vs. %ΔPPVT0−T5(BCG): 1.482 ± 0.576, p < 0.01]. Conclusion: Blood cardioplegia ameliorates CPB-induced microcirculatory alterations better than crystalloid cardioplegia in patients undergoing CABG, which may reflect attenuation of the systemic inflammatory response. Future investigations are needed to identify the underlying mechanisms of the beneficial effects of blood cardioplegia on microcirculation.
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Affiliation(s)
- Güclü Aykut
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Halim Ulugöl
- Department of Anaesthesiology and Reanimation, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Uğur Aksu
- Department of Biology, Faculty of Science, University of Istanbul, Istanbul, Turkey
| | - Sakir Akin
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands.,Department of Intensive Care, Haga Teaching Hospital, The Hague, Netherlands
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fevzi Toraman
- Department of Anaesthesiology and Reanimation, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Can Ince
- Department of Intensive Care, Laboratory of Translational Intensive Care, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, Netherlands
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Dumantepe M, Aydin S, Yildiz E, Okur HK, Kocagoz AS, Gundogdu Y, Okten M, Isbir S, Karabulut H. WITHDRAWN: Subsegmental Thrombus in COVID-19 Pneumonia: Immuno-Thrombosis or Pulmonary Embolism? Data Analysis of Hospitalized Patients with Coronavirus Disease. Heart Lung Circ 2020:S1443-9506(20)30435-2. [PMID: 32917551 PMCID: PMC7444898 DOI: 10.1016/j.hlc.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
This article has been withdrawn at the request of the author(s). The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Mert Dumantepe
- Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Selim Aydin
- Department of Cardiovascular Surgery, Acibadem Atakent Hospital, Istanbul, Turkey
| | - Erdem Yildiz
- Department of Radiology, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Hacer Kuzu Okur
- Department of Pulmonary Medicine, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - A Sesin Kocagoz
- Department of Infection Disease, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Yasemin Gundogdu
- Department of Internal Medicine, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Murat Okten
- Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Selim Isbir
- Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, Acibadem Altunizade Hospital, Istanbul, Turkey
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Dumantepe M, Aydin S, Ökten M, Karabulut H. Endophlebectomy of the common femoral vein and endovascular iliac vein recanalization for chronic iliofemoral venous occlusion. J Vasc Surg Venous Lymphat Disord 2020; 8:572-582. [DOI: 10.1016/j.jvsv.2019.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/25/2019] [Indexed: 11/26/2022]
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Dumantepe M, Okten M, Karabulut H. Heparin-bonded ePTFE Graft (Propaten) Versus Standard PTFE Graft for Arteriovenous Fistula in Hybrid Recanalization of Post-thrombotic Venous Obstruction. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dumantepe M, Okten M, Karabulut H. Endovascular Stent Graft Repair of Traumatic Popliteal Artery Injuries. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Güllü AÜ, Şenay Ş, Koçyiğit M, Ökten EM, Dumantepe M, Karabulut H, Alhan C. The feasibility of robotic-assisted concomitant procedures during mitral valve operations. Turk Gogus Kalp Damar Cerrahisi Derg 2019; 27:478-483. [PMID: 32082913 PMCID: PMC7018168 DOI: 10.5606/tgkdc.dergisi.2019.17758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 03/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND In this study, we present our clinical experience and midterm results with the robotic-assisted concomitant procedures during mitral valve operations. METHODS Between March 2010 and February 2018, a total of 34 patients (8 males, 26 females; mean age 58.3 years; range, 34 to 78 years) who underwent robotic-assisted concomitant procedures during mitral valve surgery were retrospectively analyzed. Demographic characteristics of the patients, comorbidities, medical, and surgical histories, operative and laboratory results, electrocardiographic findings, postoperative intensive care unit and ward outcomes, and cardiac follow-up data were recorded. Atrial fibrillation-related medication use, stroke, or other thromboembolic events, and electrocardiographic reports in patients who underwent cryoablation were reviewed at three and 12 months after the operation. RESULTS A total of 76 robotic-assisted concomitant procedures were performed during mitral valve repair (n=11) or replacement (n=23) in 34 patients. These procedures were cryoablation (n=29), tricuspid valve repair (n=6), tricuspid valve replacement (n=2), left atrial appendage ligation (n=32), atrial septal defect and patent foramen ovale closure (n=5), and left atrial thrombectomy (n=2). The mean preoperative EuroSCORE values were 5.1±2.5. The mean duration of cardiopulmonary bypass and cross-clamp was 156±69.4 min and 101±42 min, respectively. Normal sinus rhythm was restored in 85% of the patients (24/28) after cryoablation and two patients (5.8%) had permanent pacemaker within a year during follow-up. There was one (2.9%) mortality in the early postoperative period due to hemorrhage related to the posterior left ventricular wall rupture. No blood product was used in 82.4% of the patients. One patient had a transient cerebral event and symptoms regressed completely within two months. CONCLUSION Technological improvements and growing experience can decrease the suspects related to prolonged operational duration during robotic-assisted cardiac surgery. Concomitant procedures in addition to mitral valve operations can be performed with low complication rates in centers with experience of robotic surgery.
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Affiliation(s)
- Ahmet Ümit Güllü
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Şahin Şenay
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Muharrem Koçyiğit
- Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Eyüp Murat Ökten
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Mert Dumantepe
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
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Kocyigit M, Senay S, Gullu AU, Okten EM, Ariturk C, Toraman F, Karabulut H, Evrenkaya TR, Alhan C. Do we need a different transfusion strategy in patients with chronic kidney disease undergoing CABG? J Cardiothorac Vasc Anesth 2017. [DOI: 10.1053/j.jvca.2017.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Cardiopulmonary bypass (CPB) is one of the major tools of cardiac surgery. However, no clear data are available for the ideal value of sweep gas flow to oxygenator during CPB. The aim of this study was to determine the best value for sweep gas flow during CPB. Thirty patients undergoing isolated CABG were randomly and equally allocated into three groups. Sweep gas flow to oxygenator was kept at 1.35 l/min/m2 in group 1, 1.60 l/min/m2 in group 2, and 2.0 l/min/m2 in group 3. All patients were operated on under the same anaesthetic regime and surgical techniques. Samples for blood gas analysis were collected at T1: before CPB; T2: 5 min after the initiation of CPB; T3: just before rewarming; and T4: at the end of rewarming. Five minutes after the initiation of CPB (T2), pCO2 decreased significantly in groups 2 and 3 compared to group 1 ( p < 0.02). With the addition of hypothermia (T3), the changes in the pH and pCO2 became more profound and, in this period, the levels in group 3 patients outranged the physiologic limits, with pCO2 and pH values being 28± 3 mmHg and 7.50± 0.04, respectively. At the end of the rewarming period (T4), in spite of increased carbon dioxide production, pCO2 values were below the physiologic limits in groups 2 and 3. We conclude that sweep gas flow to the oxygenator should be kept between 1.35 and 1.60 l/min/m2 during CPB to avoid hypocapnia, which results in alkalosis and has hazardous effects on lung mechanics, cerebral blood flow, and the cardiovascular system.
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Affiliation(s)
- Hasan Karabulut
- Department of Cardiovascular Surgery, Acibadem Hospital, Kadikoy, Istanbul, Turkey
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Abstract
Hypertension following coronary artery bypass grafting is a common problem that may result in postoperative myocardial infraction or bleeding, Hemodynamic effects were compared in 45 hypertensive coronary bypass patients randomized to receive either diltiazem, nitroglycerin, or sodium nitroprusside. Diltiazem was administered as an intravenous bolus of 0.3 mg·kg−1 within 5 min, followed by infusion of 0.1–0.8 mg·kg−1·h−1 in group 1. Nitroglycerin was infused at a rate of 1–3 μg·kg·h−1 in group 2, and sodium nitroprusside was given at a rate of 1–3 μg·kg−1·min−1 in group 3. Hemodynamic measurements were carried out before infusion (T1) and at 30 min (T2), 2 h (T3), and 12 h (T4) after initiation of treatment in the intensive care unit. Mean arterial pressure decreased significantly in all groups. There were no differences among groups at T1 and T2. At T3, heart rate in group 2 was significantly higher than group 1. At T3 and T4, the double product was highest in group 3 (group 1 vs. 3, p < 0.001). These results suggest that the hemodynamic effects of the 3 drugs are similar within the first 30 min. However, after 30 min, diltiazem affords better myocardial performance and more effective control of hypertension.
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Affiliation(s)
- Fevzi Toraman
- Department of Cardiovascular Anesthesiology, Acibadem Hospital, Istanbul, Turkey
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Abstract
Although an adverse influence of hyperoxemia during cardiopulmonary bypass is well documented, there is a wide range of oxygen settings during cardiopulmonary bypass, based mostly on trial and error. The aim of this study was to determine the optimal inspired oxygen fraction during cardiopulmonary bypass. Ninety patients undergoing isolated coronary artery bypass operations were randomly allocated to one of 3 groups of 30 each. In group 1, cardiopulmonary bypass was started with an inspired oxygen fraction of 0.40, increased to 0.60 during rewarming. These settings were 0.40 and 0.50 in group 2, and 0.35 and 0.45 in group 3. Samples for blood gas analysis were collected at defined time periods during the operation. PaO2 was significantly higher in groups 1 and 2 compared to group 3. All patients in group 1 and 88% of patients in group 2 suffered at least one episode of hyperoxemia during cardiopulmonary bypass, compared to 30% of patients in group 3. The differences were significant, and we concluded that to avoid hyperoxemia, inspired oxygen fraction should be kept at 0.35 during cardiopulmonary bypass and increased to 0.45 during rewarming.
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Affiliation(s)
- Fevzi Toraman
- Department of Cardiovascular Surgery, Acibadem Kadikoy Hospital, Istanbul, Turkey
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Ulugöl H, Tosun M, Öktem M, Aksu U, Kilercik M, Karabulut H, Toraman F. Different priming solution effects on interstitial lung edema and oxidative stress parameters. J Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/j.jvca.2016.03.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hocagil AC, Bildik F, Kılıçaslan İ, Hocagil H, Karabulut H, Keleş A, Demircan A. Evaluating Unscheduled Readmission to Emergency Department in the Early Period. Balkan Med J 2016; 33:72-9. [PMID: 26966621 DOI: 10.5152/balkanmedj.2015.15917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 07/03/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The readmission in the early period (RAEP) is defined as the admission of a patient to emergency department (ED) for the second time within 72 hours after discharge from the ED. AIMS The aim of this study was to determine the disease, patient, doctor, and system related causes of RAEP. STUDY DESIGN Descriptive study. METHODS This study is a two-stage study that was conducted at Department of Emergency, Gazi University Faculty of Medicine. The causes of RAEP were defined as disease, patient, doctor, and system related causes. RESULTS A total of 46,800 adult patients admitted to ED during the study period and 779 (1.66%) patients required RAEP. After the exclusion criteria, 429 of these patients were included the study. The most common reasons for RAEP were renal colic in 46 (10.7%) patients. It was detected that 60.4% of the causes of RAEP were related to disease, 20.0% were related to the doctor, 12.1% were related to the patient, and 7.5% were related to the hospital management system. CONCLUSION This study revealed that there are patient-, doctor-, and system-related preventable reasons for RAEP and the patients requiring RAEP constitute the high risk group.
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Affiliation(s)
- Abdullah Cüneyt Hocagil
- Department of Emergency Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Fikret Bildik
- Department of Emergency, Gazi University Faculty of Medicine, Ankara, Turkey
| | - İsa Kılıçaslan
- Department of Emergency, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hilal Hocagil
- Department of Emergency Medicine, Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Hasan Karabulut
- Department of Emergency, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayfer Keleş
- Department of Emergency, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Demircan
- Department of Emergency, Gazi University Faculty of Medicine, Ankara, Turkey
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Arıtürk C, Ozgen ZS, Kilercik M, Ulugöl H, Ökten EM, Aksu U, Karabulut H, Toraman F. Comparative effects of hemodilutional anemia and transfusion during cardiopulmonary bypass on acute kidney injury: a prospective randomized study. Heart Surg Forum 2015; 18:E154-60. [PMID: 26334853 DOI: 10.1532/hsf.1387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 11/20/2022]
Abstract
AIM Acute kidney injury after cardiopulmonary bypass has been associated with dilutional anemia during surgery. We aimed both to explore if this relation is modulated by blood transfusion and to understand the postoperative contribution of protein oxidation. METHODS In this randomized prospective study, after ethics committee approval and informed consent, 30 patients undergoing first-time elective coronary artery bypass grafting (CABG) with hematocrit between 21% and 25% at any time during extracorporeal circulation (ECC) were randomly and equally allocated into two groups. Group I consisted of patients who received red blood cells (RBC) during ECC, while in Group II, patients did not receive any RBCs. Besides routine hemodynamic and biochemical parameters, markers of renal injury such as neutrophil gelatinase-associated lipocalin (NGAL), creatinine clearance, and protein oxidation parameters (advanced oxidative protein products [AOPP], total thiol [T-SH]) were determined in both groups. RESULTS (1) Both cardiovascular parameters (MAP, HR) and the hospitalization period of the transfused group were not significantly different compared to the non-transfused group (P > .05); (2) While urine NGAL level (P < .05) increased and GFR (P < .01) decreased in the transfused group compared to the preoperative period, there were no significant changes in respective parameters of the non-transfused group compared to preoperative period; (3) AOPP concentrations did not change compared to postoperative periods in both groups (P > .05). However, T-SH concentration showed a transient increased at postoperative hour 6 (P < .001 vs preoperative period) but normalized at postoperative hour 24 (P > .05 versus preoperative period). CONCLUSION These findings suggest that a hematocrit value over 21% during ECC is safe for renal functions. RBC transfusion just to increase hematocrit may be deleterious.
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Affiliation(s)
- Cem Arıtürk
- Department of Cardiovascular Surgery, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Zehra Serpil Ozgen
- Department of Anesthesiology and Reanimation, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Meltem Kilercik
- Department of Anesthesiology and Reanimation, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Halim Ulugöl
- Department of Anesthesiology and Reanimation, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Eyup Murat Ökten
- Department of Cardiovascular Surgery, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Uğur Aksu
- Istanbul University, School of Biology, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Fevzi Toraman
- Department of Anesthesiology and Reanimation, Acibadem University, School of Medicine, Istanbul, Turkey
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Arıtürk C, Özgen SU, Danışan B, Karabulut H, Toraman F. Oxygen fraction adjustment according to body surface area during extracorporeal circulation. Heart Surg Forum 2015; 18:E098-102. [PMID: 26115152 DOI: 10.1532/hsf.1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The inspiratory oxygen fraction (FiO2) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO2) to reach hyperoxemic levels (>180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO2 levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO2 levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO2 during cardiac surgery. METHODS After approval from the Ethics Committee of the University of Acıbadem, informed consent was given from 60 patients. FiO2 adjustment strategies applied to the patients in the groups were as follows: FiO2 levels were set as 0.21 × BSA during hypothermia and 0.21 × BSA + 10 during rewarming in Group I; 0.18 × BSA during hypothermia and 0.18 × BSA + 15 during rewarming in Group II; and 0.18 × BSA during hypothermia and variable with body temperature during rewarming in Group III. Arterial blood gas values and hemodynamic parameters were recorded before ECC (T1); at the 10th minute of cross clamp (T2); when the esophageal temperature (OT) reached 34°C (T3); when OT reached 36°C (T4); and just before the cessation of ECC (T5). RESULTS Mean PaO2 was significantly higher in Group I than in Group II at T2 and T3 (P = .0001 and P = .0001, respectively); in Group I than in Group III at T1 (P = .02); and in Group II than in Group III at T2, T3, and T4 (P = .0001 for all). CONCLUSION Adjustment of FiO2 according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO2 between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO2 levels in concordance with the body temperature in the rewarming period.
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Affiliation(s)
- Cem Arıtürk
- Department of Cardiovascular Surgery, Acibadem University, School of Medicine, Istanbul.
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Ariturk C, Okten M, Ozgen ZSU, Erkek E, Uysal P, Gullu U, Senay S, Karabulut H, Alhan C, Toraman F. Utility of cerebral oxymetry for assessing cerebral arteriolar carbon dioxide reactivity during cardiopulmonary bypass. Heart Surg Forum 2015; 17:E169-72. [PMID: 25002395 DOI: 10.1532/hsf98.2014319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Our study evaluated changes in cerebral arterial oxygen saturation (rSO2) during cardiopulmonary bypass (CPB) that were caused by changes in arterial carbon dioxide tension (PaCO2). METHODS A group of 126 patients undergoing routine, elective, first-time coronary artery bypass graft surgery (CABG) was entered into a prospective study using bilateral near-infrared spectroscopy (NIRS) before anesthetic induction (T1), after anesthetic induction (T2), and continuing at 5-minute intervals during moderate hypothermic (32°C) CPB. Pump flows were set at 2.5 L/min/m(2) and adjusted to maintain mean arterial pressure (MAP) within 10 mmHg of the MAP recorded at the initial fifth minute of CPB (T3). Thirty-two patients were excluded from data collection because MAP could not be stabilized within the target range of 60-90 mmHg. In the remaining 94 patients, after obtaining steady state flow, MAP, and oxygenation, a trial period of hypocarbia (mean PaCO2 of 30 mmHg) was induced by increasing oxygenator fresh gas flow rate (FGFR) to 2.5 L/min/m(2) (T4). A reciprocal period was then measured at reduced FGFR (0.75 L/min/m(2)) (T5). RESULTS After 20 minutes of a higher (2.75 L/min/m(2)) (FGFR), mean PaCO2 decreased from a baseline of 38 ± 4 mmHg to 30 ± 2 mmHg. This was associated with a parallel decrease (-10 ± 9%) in mixed cerebral oxygen saturation without alteration of mean arterial oxygen tension (PaO2), lactate, MAP, CPB flow, or other parameters implying increased cerebral oxygen extraction. CONCLUSION Parallel changes in PaCO2 and rSO2 occur during CPB when other variables remain constant, and are due to the effects of carbon dioxide on cerebral arterioles. Cerebral oxygen saturation measured by NIRS may be a useful indirect measure of PaCO2 when continuous blood gas analysis is not possible during open-heart surgery. Cerebral oximetry values may be useful measurements for setting an optimum gas flow rate through the oxygenator.
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Affiliation(s)
- Cem Ariturk
- Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey
| | - Murat Okten
- Department of Cardiovascular Surgery, Acıbadem Healthcare Group, Kadikoy Hospital
| | - Zehra Serpil Ustalar Ozgen
- Department of Anesthesiology and Reanimation, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey
| | - Esin Erkek
- Department of Anesthesiology and Reanimation, Acıbadem Healthcare Group, Kadikoy Hospital
| | - Pinar Uysal
- Department of Anesthesiology and Reanimation, Acıbadem Healthcare Group, Kadikoy Hospital
| | - Umit Gullu
- Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey
| | - Sahin Senay
- Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey
| | - Fevzi Toraman
- Department of Anesthesiology and Reanimation, University of Acıbadem Faculty of Medicine, Maltepe, Istanbul, Turkey
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Abstract
Robotic surgical techniques allow surgeons to perform mitral valve surgery. This procedure has gained acceptance, particularly for mitral valve repair in degenerative mitral disease. However, mitral repair may not always be possible, especially in severely calcified mitral valve of rheumatic origin. This study demonstrates the basic concepts and technique of robotic mitral valve replacement for valve pathologies that are not suitable for repair.
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Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Umit Gullu
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Muharrem Kocyigit
- Department of Anesthesiology and Reanimation, Acıbadem University Vocational Schools, Istanbul, Turkey
| | - Aleks Degirmencioglu
- Department of Cardiology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
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Abstract
Atrial septal defect (ASD) is one of the most common congenital cardiac diseases. This pathology can be treated with percutaneous devices. However, some of the ASDs are not suitable for device closure. Also, there may be device-related late complications of transcatheter ASD closure. Currently, robotic surgical techniques allow surgeons to close ASDs in a totally endoscopic fashion with a high success rate and a low complication rate. This study demonstrates the basic concepts and technique of robotic ASD closure.
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Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Umit Gullu
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Muharrem Kocyigit
- Department of Anesthesiology and Reanimation, Acıbadem University Vocational Schools, Istanbul, Turkey
| | - Aleks Degirmencioglu
- Department of Cardiology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, Istanbul, Turkey
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Senay S, Gullu AU, Kocyigit M, Degirmencioglu A, Kilic L, Karabulut H, Alhan C. Robotic Mitral Valve Replacement for Severe Rheumatic Mitral Disease: Perioperative Technique, Outcomes, and Early Results. Innovations 2014. [DOI: 10.1177/155698451400900406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Ahmet Umit Gullu
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | | | | | - Leyla Kilic
- Departments of Nursery, Acibadem Maslak Hospital, Istanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Istanbul, Turkey
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Buturak A, Saygili O, Ulus S, Kalfa M, Karabulut H, Alhan C, Dagdelen S, Aksu K. Right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a patient with Behçet’s disease: case report and review of the literature. Mod Rheumatol 2014; 24:532-6. [DOI: 10.3109/14397595.2013.874731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Şenay Ş, Güllü AÜ, Koçyiğit M, Değirmencioğlu A, Kılıç L, Karabulut H, Alhan C. Robotic Mitral Valve Replacement for Severe Rheumatic Mitral Disease; Perioperative Technique, Outcomes and Early Results. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Şenay Ş, Güllü AÜ, Değirmencioğlu A, Koçyiğit M, Ökten EM, Arıtürk C, Karakuş G, Zencirci E, Toraman F, Karabulut H, Alhan C. Long Term Results of Valve Sparing Aortic Root Replacement; A Single Center Experience. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Akay MH, Senay S, Karabulut H, Toraman F, Kocyiğit M, Alhan HC. Low-dose tranexamic acid use in isolated coronary artery bypass surgery. Ann Thorac Surg 2012; 94:1037-8; author reply 1038-9. [PMID: 22916772 DOI: 10.1016/j.athoracsur.2012.03.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 01/31/2012] [Accepted: 03/29/2012] [Indexed: 11/19/2022]
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23
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Buturak A, Dagdelen S, Okten M, Karabulut H. A right coronary artery saccular aneurysm leading to an embolic myocardial infarction during diagnostic cardiac catheterization: A case report. J Cardiol Cases 2012; 6:e121-e123. [PMID: 30533087 DOI: 10.1016/j.jccase.2012.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 06/12/2012] [Accepted: 07/19/2012] [Indexed: 11/28/2022] Open
Abstract
Coronary artery aneurysms are localized dilatations greater than 1.5 times the diameter of the adjacent segments. These rarely seen abnormalities may lead to serious life-threatening complications such as myocardial infarction, coronary perforation and death. Here, we present a case of periprocedural thromboembolic inferior myocardial infarction arising from a proximal right coronary artery saccular aneurysm during a diagnostic coronary angiography in a stable 70-year-old patient.
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Affiliation(s)
- Ali Buturak
- Department of Cardiology, School of Medicine, Acıbadem University, Tekin S, No. 8 Acibadem, Kadıköy, İstanbul, Turkey
| | - Sinan Dagdelen
- Department of Cardiology, School of Medicine, Acıbadem University, Tekin S, No. 8 Acibadem, Kadıköy, İstanbul, Turkey
| | - Murat Okten
- Department of Cardiovascular Surgery, Acıbadem Kadikoy Hospital, İstanbul, Turkey
| | - Hasan Karabulut
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem University, İstanbul, Turkey
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Senay S, Toraman F, Akgün Y, Aydin E, Karabulut H, Alhan C, Sarioglu T. Stroke after coronary bypass surgery is mainly related to diffuse atherosclerotic disease. Heart Surg Forum 2012; 14:E366-72. [PMID: 22167763 DOI: 10.1532/hsf98.20111031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aims to investigate the risk factors for postoperative stroke and analysis of outcome after coronary bypass surgery with cardiopulmonary bypass. METHODS Between 1999 and 2008, 3248 consecutive patients who underwent isolated coronary surgery with cardiopulmonary bypass were prospectively enrolled in the study. Demographic and perioperative data were analyzed. Postoperative stroke was defined as severe adverse neurological events including permanent deficits or cerebral lesions with radiological demonstration of cerebral infarction within the first postoperative month. RESULTS In total, 32 patients (0.9%) were determined with stroke. Univariate risk factors for postoperative stroke were determined as preoperative unstable angina (P = .006), Canadian Class of Angina (CCA) ≥ 3 (P = .001), preoperative creatinin level >1.2 mg/dL (P = .001), left main coronary artery disease (P = .04), chronic obstructive lung disease (P = .04), peripheral arterial disease (P < .001), New York Heart Association (NYHA) Class ≥ 3 (P = .004), preoperative renal insufficiency (P = .001), age > 65 years (P = .04), preoperative hypothyroidism (P = .02), postoperative low cardiac output state (P < .001), severe coronary artery disease requiring distal anastomosis ≥ 4 (P = .05), non-elective operation (P = .02), and body mass index ≥ 25 (P = .02). Multivariate analysis revealed peripheral arterial disease (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.9-14.0; P = .001), severe coronary artery disease (OR, 3.1; 95% CI, 1.1-8.5; P = .02), and postoperative low cardiac output state (OR, 5.1; 95% CI, 1.4-18.2; P = .01) as the independent risk factors. CONCLUSIONS Stroke after coronary bypass surgery with cardiopulmonary bypass is mainly related to diffuse atherosclerotic disease.
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Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acibadem University, Istanbul, Turkey.
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Dagdelen S, Aydın E, Karabulut H. Simultaneous endovascular stent and renal stent placement for acute type B aortic dissection with malperfusion of kidney. J Saudi Heart Assoc 2012; 24:141-4. [PMID: 23960684 DOI: 10.1016/j.jsha.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 12/21/2011] [Accepted: 02/05/2012] [Indexed: 10/28/2022] Open
Abstract
Acute aortic dissection frequently causes life-threatening organ ischemia. The optimal therapy for acute type-B aortic dissection is still controversial. Surgery for acute dissection with organ malperfusion is known to carry a high morbidity and mortality; however endovascular treatment is becoming an alternative form of treatment. We report a clinical case of emergency percutaneous thoracal aorta endovascular stenting and renal artery stenting in a patient who had renal malperfusion and acute renal failure due to acute type-B dissection. The present case is a fundamental examples of collaboration between the cardiologist and cardiovascular surgeon in a hybrid procedure.
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Affiliation(s)
- Sinan Dagdelen
- Acıbadem University, School of Medicine, Department of Cardiology, Istanbul
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Alhan CH, Toraman F, Karabulut H. Is increased perfusion pressure really necessary during cardiopulmonary bypass? Eur J Cardiothorac Surg 2011; 41:1213-4; author reply 1214. [PMID: 22219454 DOI: 10.1093/ejcts/ezr172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Toraman F, Senay S, Gullu U, Karabulut H, Alhan C. Readmission to the Intensive Care Unit after Fast-Track Cardiac Surgery: An Analysis of Risk Factors and Outcome according to the Type of Operation. Heart Surg Forum 2010; 13:E212-7. [DOI: 10.1532/hsf98.20101009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Senay S, Toraman F, Karabulut H, Alhan C. Efficiency of Preoperative Tranexamic Acid in Coronary Bypass Surgery: An Analysis Correlated with Preoperative Clopidogrel Use. Heart Surg Forum 2010; 13:E149-54. [DOI: 10.1532/hsf98.20091176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Senay S, Dagdelen S, Alhan C, Akyol A, Karabulut H, Toraman F, Cagil H. PP-001 TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH SEVERE COMORBIDITIES. Int J Cardiol 2010. [DOI: 10.1016/s0167-5273(10)70146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Senay S, Toraman F, Karabulut H, Alhan C. Is it the patient or the physician who cannot tolerate anemia? A prospective analysis in 1854 non-transfused coronary artery surgery patients. Perfusion 2010; 24:373-80. [DOI: 10.1177/0267659109358118] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and objective: Low hematocrit level and transfusion may coexist during cardiopulmonary bypass and the actual impact of one on the outcome parameters may be counfounded or masked by the other. This study aims to determine the impact of the lowest hematocrit level during cardiopulmonary bypass on outcome parameters in non-transfused patients. Methods: Two thousand six hundred and thirty-two consecutive patients who underwent isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass were evaluated prospectively:1854 (70.4%) patients who did not receive any red blood cells during hospital stay were included in the study. Perioperative data and outcome parameters were recorded. Outcomes were evaluated in 2 groups according to the lowest level of hematocrit (>21%: high hematocrit group, n= 1680, (91.6%) and ≤21%: low hematocrit group, n=174, (9.4%)) during cardiopulmonary bypass. Results: Overall mean lowest hematocrit level of patients was 27.7±4.4% (19.7±1.9% in the low hematocrit group, 28.5±4.1% in the high hematocrit group). The comparison of outcome parameters regarding the time on ventilator, duration of intensive care unit stay, intensive care unit re-admission, hospital re-admission, reoperation for bleeding or tamponade, low cardiac output, postoperative atrial fibrillation, stroke, creatinine level at hospital discharge, new onset renal failure, mediastinitis, pulmonary complication and mortality rates were similar in both groups. Conclusions: Our findings suggest that a lowest hematocrit level of ≤21% during cardiopulmonary bypass has no adverse impact on outcome after isolated coronary surgery in non-transfused patients.
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Affiliation(s)
- Sahin Senay
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey,
| | - Fevzi Toraman
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Hasan Karabulut
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Cem Alhan
- Acibadem University School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
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Alhan C, Karabulut H, Senay S, Cagil H, Toraman F. Endovascular treatment of occlusive abdominal aortic thrombosis. Heart Vessels 2010; 25:70-2. [PMID: 20091402 DOI: 10.1007/s00380-009-1169-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 04/08/2009] [Indexed: 11/26/2022]
Affiliation(s)
- Cem Alhan
- Department of Cardiovascular Surgery, School of Medicine, Acibadem University, Acibadem Kadikoy Hospital, Ozlem Sitesi B Blok D: 25, Kosuyolu-Uskudar, 81100 Istanbul, Turkey
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Toraman F, Evrenkaya S, Yuce M, Aksoy N, Karabulut H, Bozkulak Y, Alhan C. Lactic Acidosis after Cardiac Surgery Is Associated with Adverse Outcome. Heart Surg Forum 2009; 7:E155-9. [PMID: 15138095 DOI: 10.1532/hsf98.20041002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The accurate identification of patients who have the potential to further deteriorate after cardiac surgery is difficult. Elevated serum lactate level after cardiac surgery is an indicator of systemic hypoperfusion and tissue hypoxia. The aim of this study was to investigate the effect of increased serum lactate on outcome after on-pump coronary artery bypass grafting. METHODS Serum lactate level was measured in 776 patients within half an hour after surgery. Lactate level was less than or equal to 2 mmol/L in 534 patients (low lactate group) and more than 2 mmol/L in 242 patients (high lactate group). Continuous variables were analyzed with the Student t test. The chi 2 test and Fisher exact test were used to compare categorical variables. RESULTS Demographic characteristics and details of surgery were similar in both groups. Increased cross-clamp and cardiopulmonary bypass times and highly positive fluid balance at the end of surgery were associated with a significant rise in postoperative lactate levels, which leads to increased need for intraaortic balloon pump support (odds ration [OR], 5.9, P =.006), increased likelihood of >24 h intensive care unit stay (OR, 3.4, P =.0001), greater need for red blood cell transfusion (OR, 1.6, P =.002), increased length of hospital stay, and higher mortality rates (OR, 5.6, P =.04). CONCLUSIONS This study has demonstrated that elevated blood lactate level is associated with adverse outcome, and monitoring the blood lactate level during and after cardiac surgery is a valuable tool in identifying the patients who have the potential to deteriorate.
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Affiliation(s)
- Fevzi Toraman
- Departments of Anesthesiology, Acibadem Kadiköy Hospital, Istanbul, Turkey.
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Senay S, Toraman F, Gelmez S, Dağdelen S, Karabulut H, Alhan C. Continuous arterial pressure waveform analysis accurately detects cardiac output in cardiac surgery: a prospective comparison with thermodilution, echocardiography, and magnetic resonance techniques. Heart Surg Forum 2009; 12:E75-8. [PMID: 19383591 DOI: 10.1532/hsf98.20081142] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to compare the accuracy of cardiac output (CO) measurements of noninvasive continuous arterial pressure waveform analysis, thermodilution technique and echocardiography with magnetic resonance (MRI) imaging. METHODS Eleven patients who underwent coronary bypass surgery under cardiopulmonary bypass were prospectively enrolled in this study in 2008. Repeated arterial pressure based, thermodilution, echocardiography, and MRI cardiac output measurements were performed at the postoperative 24th hour. RESULTS Mean CO values were 5.58 +/- 0.98, 5.97 +/- 0.8, 5.31 +/- 0.52, and 5.32 +/- 0.92 measured with MRI, echocardiography, arterial pressure waveform analysis, and thermodilution techniques, respectively. Bland-Altman analysis showed good overall agreement between the MRI vs arterial waveform analysis and MRI vs thermodilution; values for bias +/- SD were -0.27 +/- 1.06 (95% confidence interval [CI] [-2.3 to 1.8]; P = .42) and -0.26 +/- 0.89 (95% CI [-2.0 to 1.5]; P = .34), respectively. Poor agreement was defined between MRI and echocardiography: bias +/- SD, 0.39 +/- 1.28 (95% CI [-2.1 to 2.9]; P = .34). CONCLUSIONS Arterial pressure-based and thermodilution CO measurement systems yielded results comparable to those obtained with cardiac MRI assessment after cardiac surgery. Arterial pressure wave-form analysis systems for CO measurement may be feasible, noninvasive methods for use in cardiac surgery.
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Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acibadem University School of Medicine, Acibadem Kadikoy Hospital, Istanbul, Turkey.
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35
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Karabulut H, Arıman Karabulut H. Stochastic theory of direct simulation Monte Carlo method. Theor Chem Acc 2009. [DOI: 10.1007/s00214-009-0533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Karabulut H, Senay S, Toraman F, Alhan C. Treatment of delayed retrograde dissection after endovascular stenting of thoracoabdominal aortic aneurysm: graft-to-endograft anastomosis. Heart Surg Forum 2009; 12:E61-2. [PMID: 19233770 DOI: 10.1532/hsf98.20081106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Endovascular treatment of thoracic aortic aneurysms may be associated with procedure-related early and late complications. REPORT We describe the case of a 70-year-old man who developed acute retrograde dissection of the ascending aorta 30 days after endovascular stent grafting of a thoracoabdominal aortic aneurysm and prior revascularization of the left subclavian artery. The ascending aorta and aortic arch were successfully replaced with a Dacron graft; the distal part of the graft was partially anastomosed to the previously placed endograft. DISCUSSION Surgical repair of dissections following a thoracic endovascular procedure is reliable with a graft-to-endograft anastomosis when native aortic tissue is not suitable.
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Affiliation(s)
- Hasan Karabulut
- Acibadem University, School of Medicine, Department of Cardiovascular Surgery, Istanbul, Turkey
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37
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Acar B, Babademez MA, Karabulut H, Karasen RM. An unusual cause of dysphonia: laryngeal verruca vulgaris. B-ENT 2009; 5:183-187. [PMID: 19902857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
PROBLEMS/OBJECTIVES Verruca vulgaris of the larynx (VVL) is an uncommon lesion with clinical and histopathological features that are easily misdiagnosed as verrucous carcinoma, and thus may lead to unnecessary surgery. This case study investigated clinical and pathological features that might distinguish VVL from other keratotic laryngeal lesions. METHODOLOGY A 35-year-old man presented with a 3-month history of progressive hoarseness and superficial, keratotic, vocal cord lesions. The verrucoid configuration of the surface and lack of nuclear atypia enabled treatment by local excision. The biopsied lesion was sectioned and examined by immunohistochemistry, and in situ hybridization. RESULTS The patient was disease-free up to 1 year and 6 months after surgery. The exophytic, keratotic lesions of the larynx had features of cutaneous verruca vulgaris. No human papilloma virus was detected. CONCLUSIONS We described histopathological features of VVL that will facilitate its distinction from laryngeal keratosis, squamous papillomas, verrucous hyperplasia, and verrucous carcinoma.
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Affiliation(s)
- B Acar
- Kecioren Training and Research Hospital, Department of Otorhinolaryngology, Ankara, Turkey.
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Senay S, Toraman F, Gunaydin S, Kilercik M, Karabulut H, Alhan C. The impact of allogenic red cell transfusion and coated bypass circuit on the inflammatory response during cardiopulmonary bypass: a randomized study. Interact Cardiovasc Thorac Surg 2008; 8:93-9. [DOI: 10.1510/icvts.2008.183608] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Senay S, Alhan C, Karabulut H, Toraman F, Cagil H. Endovascular Treatment of Rapidly Expanding Thoracoabdominal Aortic Aneurysm After Surgical Repair of Acute Type A Dissection. Ann Thorac Surg 2008; 85:636-8. [DOI: 10.1016/j.athoracsur.2007.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 08/24/2007] [Accepted: 08/27/2007] [Indexed: 10/22/2022]
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41
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Karabulut H, Senay S, Toraman F, Cagil H, Alhan C. Primary Endovascular Treatment of Native Thoracic Aortic Aneurysm Associated with Coarctation. Eur J Vasc Endovasc Surg 2007. [DOI: 10.1016/j.ejvs.2007.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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42
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Senay S, Alhan C, Toraman F, Karabulut H, Dagdelen S, Cagil H. Endovascular Stent-graft Treatment of Type A Dissection: Case Report and Review of Literature. Eur J Vasc Endovasc Surg 2007; 34:457-60. [PMID: 17681823 DOI: 10.1016/j.ejvs.2007.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Accepted: 06/12/2007] [Indexed: 11/26/2022]
Abstract
We report a successful endovascular stent-graft treatment of a patient with type A dissection with primary entry tear at the ascending aorta. Simultaneous coronary stenting was performed. A literature review was performed and the possible use of endovascular treatment for ascending aortic dissections is discussed.
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Affiliation(s)
- S Senay
- Department of Cardiovascular Surgery, Acibadem Kadikoy Hospital, Istanbul, Turkey.
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Senay S, Damlacik A, Karabulut H, Toraman F, Alhan C. Endovascular Treatment of Traumatic Thoracic Aortic Transection—Role of Timing: A Case Report. Heart Surg Forum 2007; 10:E271-2. [PMID: 17599872 DOI: 10.1532/hsf98.20071045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical management of traumatic thoracic aortic transection gains importance because of controversial approaches regarding diagnosis, treatment choices, and the timing of treatment modalities. We report on an emergency endovascular stent graft implacement for a patient with acute traumatic thoracic aortic transection and discuss the role of timing for this kind of procedure.
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Affiliation(s)
- Sahin Senay
- Department of Cardiovascular Surgery, Acibadem Kadikoy Hospital, Istanbul, Turkey.
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Alhan C, Senay S, Evrenkaya S, Toraman F, Karabulut H. Hybrid Treatment of Ascending Aortic Pseudoaneurysm: Endovascular Stent-graft Placement and Extraanatomic Reconstruction without Sternotomy. Eur J Vasc Endovasc Surg 2007; 33:306-8. [PMID: 17097895 DOI: 10.1016/j.ejvs.2006.09.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 09/18/2006] [Indexed: 11/21/2022]
Abstract
Conventional surgical repair of ascending aortic pseudoaneurysms following prior cardiac operations is performed with a high operative mortality. We report a 67 year old female patient with an ascending aortic pseudoaneurysm detected 3 years after coronary bypass surgery. The patient was treated with ascending aortic endovascular stent graft placement and extraanatomic reconstruction of supraaortic branches without using sternotomy.
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Affiliation(s)
- C Alhan
- Department of Cardiovascular Surgery, Acibadem Kadikoy Hospital, Istanbul, Turkey
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Baser S, Ozkurt S, Topuz B, Kiter G, Karabulut H, Akdag B, Evyapan F. Peak expiratory flow monitoring to screen for asthma in patients with allergic rhinitis. J Investig Allergol Clin Immunol 2007; 17:211-5. [PMID: 17694692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
AIM To investigate the benefit of using peak expiratory flow (PEF) monitoring to screen for asthma in allergic rhinitis patients. METHODS Eighty-nine consecutive patients with allergic rhinitis but never assessed for asthma were included in this prospective study. Their allergic status was determined by skin prick tests. All of the subjects filled in a questionnaire on asthma-like symptoms. If they reported such symptoms, pulmonary function tests were carried out. Then, PEF was checked twice daily for 3 weeks. RESULTS Thirty-six percent of our study group were male and 64% were female patients with a mean (SD) age of 36.3 (14.0) years. Skin prick tests were positive to grass mixture in 71 (79.8%) patients, to tree mixture in 51 (57.3%), to mite in 46 (51.7%), and to epidermal mix in 26 (29.2%) patients. Thirty-six patients (41%) reported 3 or more asthma symptoms. Lung function test results for these 36 patients showed obstruction for 11.1% (4 patients); the remaining patients (88.9%) had normal function parameters. The subjects who reported 3 or more asthma symptoms but had normal lung function monitored their PEF for 3 weeks. Sixteen (50%) patients from this group and the 4 patients with demonstrated airway obstruction had more than 20% diurnal variation in PEF. These 20 patients' asthma symptoms disappeared after they received 3 months of low-dose inhaled corticosteroid therapy. CONCLUSION It is necessary to look for asthma in patients suffering from allergic rhinitis. PEF monitoring is a low-cost, objective approach to asthma diagnosis that can be performed by a patient with allergic rhinitis even if spirometry is normal. Knowledge of this technique is of utmost importance because delay in diagnosis will result in the unsatisfactory treatment of the disease.
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Affiliation(s)
- S Baser
- Pamukkale University Medical Faculty, Department of Pulmonary Diseases, Denizli, Turkey.
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Eryilmaz A, Dagli M, Karabulut H, Sivas Acar F, Erkol Inal E, Gocer C. Evaluation of hearing loss in patients with ankylosing spondylitis. J Laryngol Otol 2006; 121:845-9. [PMID: 17125576 DOI: 10.1017/s0022215106004488] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2006] [Indexed: 11/06/2022]
Abstract
AIMS The aim of this study was to investigate hearing loss in patients with ankylosing spondylitis. STUDY DESIGN Prospective, case-control study. METHODS Fifty-nine ankylosing spondylitis patients (118 ears) and 52 healthy control subjects (104 ears) were included. Pure tone audiometry at 250, 500, 1000, 2000, 4000 and 6000 Hz and immittance measures, including tympanometry and acoustic reflex tests, were performed in the patients and controls. RESULTS Sensorineural hearing loss was found in 21 patients (35.5 per cent), bilateral in 15 patients and unilateral in six. Pure tone thresholds significantly differed between patients and controls at all frequencies (p<0.05). There was no statistically significant difference between the right and the left ears' thresholds at all frequencies, except at 4000 Hz in ankylosing spondylitis patients. The right ears' thresholds were higher than those of the left ears. Patients' pure tone average (PTA) thresholds were significantly different from those of controls in all three PTA groups (i.e. 250 Hz; 500, 1000 and 2000 Hz; and 4000 and 6000 Hz) (p<0.05). The differences were most prominent in the higher frequencies. CONCLUSION Our findings suggest a decreased hearing level in ankylosing spondylitis patients, mostly at high frequencies, although the pure tone thresholds of patients and controls significantly differed at all frequencies.
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Affiliation(s)
- A Eryilmaz
- Department of Otolaryngology, Ankara Numune Research and Training Hospital, Ankara, Turkey
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Toraman F, Evrenkaya S, Yuce M, Turek O, Aksoy N, Karabulut H, Demirhisar O, Alhan C. Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome. Perfusion 2005; 19:85-91. [PMID: 15162922 DOI: 10.1191/0267659104pf723oa] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
UNLABELLED Hemodilution and increase in capillary permeability occurring with cardiopulmonary bypass (CPB) impose a risk for tissue edema and blood transfusion that may result in an increased complication rate after coronary artery bypass grafting (CABG). Of the 1280 consecutive patients undergoing isolated on-pump CABG, total fluid balance at the end of the operation was less than or equal to 500 mL in 1155 (Group 1) and more than 500 mL in 125 (Group 2). During CPB, blood was added to the reservoir only when the hematocrit fell to 17% or less and crystalloid solution only when the pump flow index fell below 2.0 L/min/m2. Anesthetic, surgical, and postoperative management and diagnoses were the same in all patients, and a single surgical and anesthesia team performed all operations. No patient was excluded from the study. RESULTS Hypertension, diabetes, chronic obstructive pulmonary disease, New York Heart Association (NYHA) Class III-IV, use of angiotensin converting enzyme (ACE) inhibitors, chronic renal failure, and female gender were the significant preoperative risk factors for increased volume replacement during CPB. The groups were similar in body mass index, preoperative hematocrit values, total fluid balance in the intensive care unit (ICU), and total chest tube output. However, red blood cells' transfusion rate, readmission rate to the ICU and length of hospital stay were significantly higher in Group 2 patients. Multiple logistic regression revealed that age > 70 years (p < 0.001, Odds Ratio (OR): 2, 95% CI: 1.4-2.8), and total fluid balance > 500 mL at the end of the operation (p < 0.01, OR: 2.2, 95% CI: 1.5-3.2) were the predictors of increased length of stay. For transfusion of red blood cells, age > 70 years (p < 0.0001, OR: 2.3, 95% CI: 1.6-3.3), and total fluid balance > 500 mL at the end of the operation (p < 0.001, OR: 2, 95% CI: 1.3-2.9) were the only significant risk factors. This study suggests that intraoperative volume overload increases blood transfusion and length of hospital stay in patients undergoing CABG.
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Affiliation(s)
- Fevzi Toraman
- Department of Anesthesiology, Acibadem Kadiköy Hospital, Istanbul, Turkey
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Abstract
Objective: Fast-track recovery protocols result in shorter hospital stays and decreased costs in coronary artery bypass grafting (CABG) surgery. However, data based on an objective scoring system are lacking for the impact of these protocols on patients undergoing cardiac surgery other than isolated CABG. Methods: Between March 1999 and March 2003, 299 consecutive patients who underwent open cardiac surgery other than isolated CABG were analyzed to evaluate the safety and efficacy of fast-track recovery. The parameters evaluated as predictors of mortality, ie, delayed extubation (>360 minutes), intensive care unit (ICU) discharge (>24 hours), increased length of hospital stay (>5 days), and red blood cell transfusion, were determined by regression analysis. Standard perioperative data were collected prospectively for every patient. Results: Seventy-two percent of the patients were extubated within 6 hours, 87% were discharged from the ICU within 24 hours, and 60% were discharged from the hospital within 5 days. No red blood cells were transfused in 67% of the patients. There were no predictors of mortality. The predictors of delayed extubation were preoperative congestive heart failure (P = .005; odds ratio [OR], 4.5; 95% confidence interval [CI], 1.6-12.6) and peripheral vascular disease (P = .02; OR, 6; 95% CI, 1.9-19.4). Factors leading to increased ICU stay were diabetes (P = .05; OR, 3.6; 95% CI, 1-12.6), emergent operation (P = .04; OR, 6.1; 95% CI, 1.1-33.2), red blood cell transfusion (P = .03; OR, 2.9; 95% CI, 1.1-7.8), chest tube drainage >1000 mL (P = .03; OR, 3.4; 95% CI, 1.1-10.2). The predictors of increased length of hospital stay were ICU stay >24 hours (P = .001; OR, 5.9; 95% CI, 2-17), EuroSCORE >5 (P = .05; OR, 1.8; 95% CI, 1-3.2), and chronic obstructive pulmonary disease (P = .003; OR, 3.7; 95% CI, 1.5-8.7). Predictive factors for transfusion of red blood cells were diabetes (P = .04; OR, 2.9; 95% CI, 1.1-8.1), delayed extubation (P = .02; OR, 2.7; 95% CI, 1.4-5.1), increased ICU stay (P = .04; OR, 2.6; 95% CI, 1-6.4), and chest tube drainage >1000 mL (P = .001; OR, 4.3; 95% CI, 2-9.3). Conclusions: This study confirms the safety and efficacy of the fast-track recovery protocol in patients undergoing open cardiac surgery other than isolated CABG.
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Affiliation(s)
- Fevzi Toraman
- Department of Anesthesiology, Acibadem Kadiköy Hospital, Istanbul, Turkey.
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Dagdelen S, Yuce M, Toraman F, Karabulut H, Alhan C. The value of P dispersion on predicting atrial fibrillation after coronary artery bypass surgery; effect of magnesium on P dispersion. ACTA ACUST UNITED AC 2004; 7:162-4. [PMID: 14618043 DOI: 10.1023/a:1027419701792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Atrial fibrillation (AF) is a frequent arrhythmia complicating cardiac surgery, and generally occurs within the first week after surgery. Although there are some etiological mechanisms to explain the postoperative AF, the exact mechanisms of AF are not well clarified. In the present study, we would like to show the effect of MgSO(4) infusion on P duration and P dispersion, and its relation with AF complication in patients undergoing coronary artery bypass grafting. The patients were randomly allocated into two groups. Group A consisted of 93 patients to whom 1.5 g/day MgSO(4) infusion in 100 mL 0.9 NaCl solution (25 mL/hr) were applied the day before surgery, just after operation, and once daily for 4 days following surgery. Group B consisted of 55 control patients to whom 100 mL 0.9 NaCl solution (25 mL/hr) were applied at the same time points. Magnesium level was measured before the treatment and daily for the postoperative four days. As a result, AF developed in 2% of cases in group A, and in 36% of cases in group B (p < 0.001). Comparing the patients who developed AF, and who did not, no difference was detected with regard to baseline P max, P min, P dispersion and fourth day P min. But fourth day P max and P dispersion of patients who developed AF were significantly higher than who did not. Baseline Mg level were similar for those who developed AF, and who did not, but fourth day Mg level was significantly lower in AF group. As a result, our opinion that Mg infusion significantly decreased the incidence AF after cardiac bypass surgery was confirmed. And it's also clear that beneficial effect of MgSO(4) is associated with its decreasing effect on P dispersion.
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Affiliation(s)
- Sinan Dagdelen
- Acibadem Hospital, Tekin sk. No: 18, Acibadem, Kadikoy/Istanbul, Turkey.
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