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Kurt M, Isik O, Cubukcu E, Gorken IB, Ozturk E, Terzi C, Yılmazlar T. A Comparison of Standard Neoadjuvant Long-Course Chemoradiotherapy and Near-Total Neoadjuvant Therapy in Rectal Cancer: A Matched Pair Analysis at Equal Time Interval. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.990] [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: 10/31/2022]
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Terzi C, Bingul M, Arslan NC, Ozturk E, Canda AE, Isik O, Yilmazlar T, Obuz F, Birkay Gorken I, Kurt M, Unlu M, Ugras N, Kanat O, Oztop I. Randomized controlled trial of 8 weeks' vs 12 weeks' interval between neoadjuvant chemoradiotherapy and surgery for locally advanced rectal cancer. Colorectal Dis 2020; 22:279-288. [PMID: 31566843 DOI: 10.1111/codi.14867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/14/2019] [Indexed: 12/12/2022]
Abstract
AIM The aim was to compare the pathological complete response (pCR) rate at 8 compared to 12 weeks' interval between completion of neoadjuvant chemoradiotherapy (CRT) and surgery in patients with locally advanced rectal cancer. METHOD This was a randomized trial which included a total of 330 patients from two institutions. Patients with locally advanced (T3-4N0M0, TxN+M0) rectal cancer were randomized into 8- and 12-week interval groups. All the patients received long-course CRT (45 Gy in 1.8 Gy fractions and concomitant oral capecitabine or 5-fluorouracil infusion). Surgery was performed at either 8 or 12 weeks after CRT. The primary end-point was pCR. Secondary end-points were sphincter preservation, postoperative morbidity and mortality. RESULTS Two-hundred and fifty-two patients (n = 125 in the 8-week group, n = 127 in the 12-week group) were included. Demographic and clinical characteristics were similar between groups. The overall pCR rate was 17.9% (n = 45): 12% (n = 15) in the 8-week group and 23.6% (n = 30) in the 12-week group (P = 0.021). Sphincter-preserving surgery was performed in 107 (85.6%) patients which was significantly higher than the 94 (74%) patients in the 12-week group (P = 0.016). Postoperative mortality was seen in three (1.2%) patients overall and was not different between groups (1.6% in 8 weeks vs 0.8% in 12 weeks, P = 0.494). Groups were similar in anastomotic leak (10.8% in 8 weeks vs 4.5% in 12 weeks, P = 0.088) and morbidity (30.4% in 8 weeks and 20.1% in 12 weeks, P = 0.083). CONCLUSION Extending the interval between CRT and surgery from 8 to 12 weeks resulted in a 2-fold increase in pCR rate without any difference in mortality and morbidity.
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Affiliation(s)
- C Terzi
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - M Bingul
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - N C Arslan
- Department of General Surgery, Medipol University, Istanbul, Turkey
| | - E Ozturk
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - A E Canda
- Department of General Surgery, Dokuz Eylul University, Izmir, Turkey
| | - O Isik
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - T Yilmazlar
- Department of General Surgery, Uludag University Hospital, Bursa, Turkey
| | - F Obuz
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
| | - I Birkay Gorken
- Department of Radiation Oncology, Dokuz Eylul University, Izmir, Turkey
| | - M Kurt
- Department of Radiation Oncology, Uludag University Hospital, Bursa, Turkey
| | - M Unlu
- Department of Pathology, Dokuz Eylul University, Izmir, Turkey
| | - N Ugras
- Department of Pathology, Uludag University Hospital, Bursa, Turkey
| | - O Kanat
- Department of Medical Oncology, Uludag University Hospital, Bursa, Turkey
| | - I Oztop
- Department of Medical Oncology, Dokuz Eylul University, Izmir, Turkey
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Kaya E, Isik O. Long-segment patchplasty of diffuse left anterior descending artery disease on the beating heart. Cardiovasc J Afr 2019; 30:57-60. [PMID: 30720843 DOI: 10.5830/cvja-2018-062] [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: 08/06/2018] [Accepted: 10/31/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The rate of patients with diffuse left anterior descending artery (LAD) disease being referred for surgery has increased as a result of advances in endovascular techniques. In surgery of diffuse or multisegment LAD disease, surgical procedures with or without endarterectomy can be performed. In this article, we report our results of longsegment onlay patchplasty of the LAD with a left internal thoracic artery (LITA) graft without endarterectomy, on the beating heart, in patients with multisegment LAD disease. METHODS We retrospectively analysed patients who underwent coronary artery bypass grafting surgery in our hospital between 1 January 2015 and 31 July 2017. We included LITA onlay patchplasty patients with multisegment LAD disease who had been operated on the beating heart. We excluded patients who underwent coronary endarterectomy and were operated on under cardiopulmonary bypass. RESULTS In this period, 54 patients with multisegment LAD disease were treated with LITA patchplasty on the beating heart. The mean length of the arteriotomy was 42.8 ± 13.3 mm (25-75 mm). There were two postoperative myocardial infarctions (3.7%) and three deaths (5.5%). In the remaining patients, there was no haemodynamic instability that needed long-term (> 24 hour) inotropic support. Patients were discharged from hospital on postoperative 9.3 ± 7.1 days with dual antiplatalet therapy. CONCLUSIONS Bypass grafting of the LAD with long-segment LITA onlay patchplasty can safely be performed in patients with multisegment LAD disease, with acceptable early-term results. In this procedure, proximal and distal segments of the diseased LAD are revascularised with LITA grafts, which may improve long-term survival and quality of life.
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Affiliation(s)
- Erhan Kaya
- Department of Cardiovascular Surgery, Private Pendik Regional Hospital, Istanbul, Turkey.
| | - Omer Isik
- Department of Cardiovascular Surgery, Private Pendik Regional Hospital, Istanbul, Turkey
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Wong A, Isik O, Abbas MA, Gorgun E. Laparoscopic-assisted endoscopic full-thickness resection of a colonic lesion - a video vignette. Colorectal Dis 2016; 18:217. [PMID: 26583356 DOI: 10.1111/codi.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/07/2015] [Indexed: 02/08/2023]
Affiliation(s)
- A Wong
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, Ohio, 44195, USA
| | - O Isik
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, Ohio, 44195, USA
| | - M A Abbas
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, Ohio, 44195, USA
| | - E Gorgun
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave. A-30, Cleveland, Ohio, 44195, USA.
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Isik O, Kaya E, Dundar HZ, Sarkut P. Surgical Site Infection: Re-assessment of the Risk Factors. Chirurgia (Bucur) 2015; 110:457-461. [PMID: 26531790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a well-known complication of general surgery. Although overall SSI rate is relatively low, it is the most common nosocomial infection. SSI adversely affects patient outcomes and healthcare costs. METHODS Patients who underwent general surgical procedures between 2003 and 2009 were included in the study. SSI diagnosed based on the National Nosocomial Infection Surveillance System (NNIS) criteria. Patients were classified into two groups: SSI (+) and SSI (-). Patient demographics, co-morbidities, procedural details, and SSI type and treatment were evaluated. Multivariate analysis was performed to determine independent risk factors of SSI. RESULTS In total, 4690 patients were included. Overall SSI rate was 4.09% (192/ 4690). Colorectal surgery was associated with the highest SSI rate (9.43%) followed by pilonidal sinus (8.79%), upper gastrointestinal (GI) (8.09%), hepatobiliary (6.68%), hernia (0.78%), and breast-thyroid (0.3%) surgery. Procedure type (pilonidal sinus, colorectal, hepatobiliary and upper GI surgery), prolonged preoperative hospital stay, higher ASA score, emergency surgery, dirty- infected wound class, experienced surgeon, prolonged operating time, presence of surgical drains, and intraoperative transfusion were determined as independent risk factors of SSI (p 0.05). CONCLUSION Most of the determined risk factors were surgeon and procedure related. Reduced SSI rate and better outcomes can be achieved by controlling modifiable risk factors.
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Tumay V, Guner OS, Meric M, Isik O, Zorluoglu A. Endoscopic Removal of Duodenal Perforating Fishbone - A Case Report. Chirurgia (Bucur) 2015; 110:471-473. [PMID: 26531793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accidental ingestion of foreign bodies is common in clinical practice. While perforation of the ileum and jejunum due to the ingested foreign body is common, duodenal perforation is rare. In this report, our experience with this rare entity is shared. CASE REPORT Here we present a 31-year-old patient with gastrointestinal tract perforation at the second part of the duodenum due to an ingested fishbone. The patient was admitted to the emergency room with abdominal pain. Right upper quadrant tenderness was detected at physical examination, and leukocytosis on the laboratory test results. Ultra-sonography was not diagnostic, however, computerized tomo-graphy showed an ingested foreign body in the second part of the duodenum. A fishbone perforating the duodenum was retrieved by endoscopy. The patient was managed non-operatively, and discharged without any problems on the third day after endoscopy. CONCLUSION Endoscopic removal and non-operative management may be feasible in carefully selected patients with duodenal perforated fishbone ingestion.
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Ugurlucan M, Basaran M, Erdim F, Selimoglu O, Caglar IM, Zencirci E, Filizcan U, Ogus NT, Yildiz Y, Tireli E, Isik O, Dayioglu E. Pressure-controlled mechanical ventilation is more advantageous in the follow-up of patients with chronic obstructive pulmonary disease after open heart surgery. Heart Surg Forum 2015; 17:E1-6. [PMID: 24631983 DOI: 10.1532/hsf98.2013236] [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
OBJECTIVE Cardiopulmonary bypass deteriorates pulmonary functions to a certain extent. Patients with chronic obstructive pulmonary disease (COPD) are associated with increased mortality and morbidity risks in the postoperative period of open-heart surgery. In this study we compared 2 different mechanical ventilation modes, pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV), in this particular patient population. PATIENTS AND METHODS Forty patients with severe COPD were assigned to 1 of 2 groups and enrolled to receive PCV or VCV in the postoperative period. Arterial blood gases, respiratory parameters, and intensive care unit and hospital stays were compared between the 2 groups. RESULTS Maximum airway pressure was higher in the VCV group. Pulmonary compliance was lower in the VCV group and minute ventilation was significantly lower in the group ventilated with PCV mode. The respiratory index was increased in the PCV group compared with the VCV group and with preoperative findings. Duration of mechanical ventilation was significantly shorter with PCV; however, intensive care unit and hospital stays did not differ. CONCLUSION There is not a single widely accepted and established mode of ventilation for patients with COPD undergoing open-heart surgery. Our modest experience indicated promising results with PCV mode; however, further studies are warranted.
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Affiliation(s)
- Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Murat Basaran
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Filiz Erdim
- Cardiovascular Surgery Clinic, Istanbul Cerrahi Hospital, Istanbul, Turkey
| | - Ozer Selimoglu
- Cardiovascular Surgery Clinic, Istanbul Cerrahi Hospital, Istanbul, Turkey
| | - Ilker Murat Caglar
- Cardiology Clinic, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | | | - Ugur Filizcan
- Department of Cardiovascular Surgery, Maltepe University Medical Faculty, Istanbul, Turkey
| | | | - Yahya Yildiz
- Cardiovascular Surgery Clinic, Pendik Bolge Hospital, Istanbul, Turkey
| | - Emin Tireli
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Omer Isik
- Cardiovascular Surgery Clinic, Pendik Bolge Hospital, Istanbul, Turkey
| | - Enver Dayioglu
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Uyar I, Demir T, Uyar GU, Tulukoglu E, Parlar AI, Isik O. Five-year follow up of Konno aortoventriculoplasty for repeat aortic valve replacement in an adult patient. Cardiovasc J Afr 2015; 26:e1-3. [PMID: 25784495 DOI: 10.5830/cvja-2014-059] [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: 04/28/2014] [Accepted: 09/18/2014] [Indexed: 11/06/2022] Open
Abstract
Konno aortoventriculoplasty (AVP) is performed for various types of left ventricular outflow tract obstruction. We report on a 32-year-old woman who had undergone double valve replacement five years earlier. She presented with increased interventricular septum thickness, small aortic root and gradient across the aortic mechanical valve. We performed Konno AVP with repeat aortic valve replacement (AVR). The control echocardiography showed no significant residual gradient. Konno AVP with repeat AVR may be safely performed with satisfactory results.
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Affiliation(s)
| | | | | | | | | | - Omer Isik
- Akut Kalp Damar Hastanesi, Izmir, Turkey
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Yildiz Y, Salihoglu E, Celik S, Ugurlucan M, Caglar IM, Turhan-Caglar FN, Isik O. The effect of postoperative positive end-expiratory pressure on postoperative bleeding after off-pump coronary artery bypass grafting. Arch Med Sci 2014; 10:933-40. [PMID: 25395944 PMCID: PMC4223138 DOI: 10.5114/aoms.2014.46213] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 05/30/2012] [Accepted: 07/10/2012] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION To compare postoperative prophylactic use of two positive end-expiratory pressure (PEEP) levels in order to prevent postoperative bleeding in patients undergoing off-pump coronary artery bypass grafting (CABG) surgery. MATERIAL AND METHODS Sixty patients undergoing an elective off-pump CABG operation were included in this prospective, nonrandomized clinical trial. Patients were divided into two groups as receiving either 5 cm H2O (group 1) or 8 cm H2O PEEP (group 2) after the operation until being extubated. Chest tube outputs, use of blood products and other fluids, postoperative hemoglobin levels, accumulation of pleural and pericardial fluid after the removal of chest tubes, and duration of hospital stay were recorded and compared. RESULTS Low- and high-pressure PEEP groups did not differ with regard to postoperative chest tube outputs, amounts of transfusions and crystalloid/colloid infusion requirements, or postoperative hemoglobin levels. However, low-pressure PEEP application was associated with significantly higher pleural (92 ±37 ml vs. 69 ±29 ml, p = 0.03) and pericardial fluid (17 ±5 ml vs. 14 ±6 ml, p = 0.04) accumulation. On the other hand, high-pressure PEEP application was associated with significantly longer duration of hospitalization (6.25 ±1.21 days vs. 5.25 ±0.91 days, p = 0.03). CONCLUSIONS Prophylactic administration of postoperative PEEP levels of 8 cm H2O, although safe, does not seem to reduce chest-tube output or transfusion requirements in off-pump CABG when compared to the lower level of PEEP. Further studies with larger sample sizes are warranted to confirm the benefits and identify ideal levels of PEEP administration in this group of patients.
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Affiliation(s)
- Yahya Yildiz
- Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey
| | - Ece Salihoglu
- Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey
| | - Sezai Celik
- Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Ilker Murat Caglar
- Department of Cardiology, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Omer Isik
- Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Istanbul, Turkey
- Department of Cardiovascular Surgery, Pendik Bolge Hospital, Istanbul, Turkey
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Kaya E, Yerebakan H, Spielman D, Isik O, Yakut C. Acute type-A aortic dissection with obstruction of the right coronary artery. Heart Surg Forum 2014; 17:E196-7. [PMID: 25179971 DOI: 10.1532/hsf98.2013246] [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] [Indexed: 11/20/2022]
Abstract
Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.
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Affiliation(s)
- Erhan Kaya
- Özel Pendik Bölge Hastanesi, Pendik, Istanbul, Turkey
| | - Halit Yerebakan
- New York Presbyterian Hospital, Division of Cardiothoracic Surgery, College of Physicians & Surgeons of Columbia University, New York, New York, USA
| | - Daniel Spielman
- New York Presbyterian Hospital, Division of Cardiothoracic Surgery, College of Physicians & Surgeons of Columbia University, New York, New York, USA
| | - Omer Isik
- Özel Pendik Bölge Hastanesi, Pendik, Istanbul, Turkey
| | - Cevat Yakut
- Özel Pendik Bölge Hastanesi, Pendik, Istanbul, Turkey
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Uyar I, Demir T, Polat A, Bahceci F, Isik O. Innominate artery as an alternative site for proximal anastomoses in patients with a severely calcified aorta. J Card Surg 2013; 28:228-32. [PMID: 23675680 DOI: 10.1111/jocs.12112] [Citation(s) in RCA: 1] [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: 11/30/2022]
Abstract
BACKGROUND Atheromatous plaques of the ascending aorta are one of the most important risk factors for postoperative mortality and morbidity in coronary artery bypass grafting (CABG). We have retrospectively analyzed the results of proximal anastomoses constructed on the innominate artery in patients with calcific atheromatous plaques (CAP) in their ascending aorta detected intraoperatively. PATIENTS AND METHODS This study is a retrospective review of 16 consecutive patients who underwent CABG operations and had CAP on their ascending aorta between November 2006 and June 2009. The atheromatous lesions were detected intraoperatively and the operation plan was changed to off-pump surgery. All the proximal anastomoses were made on the innominate artery, left internal thoracic artery (LITA) or the other saphenous vein grafts (SVG). Thirteen patients were male and three were female with a mean age of 63.7 ± 5.3 (ranged, 53-71) years. RESULTS A total of 56 distal anastomoses (3.5 per patient) and 25 proximal anastomoses on the innominate artery were performed. Of the 16 patients, seven (43.7%) had received a sequential SVG; two (12.5%) patients, sequential LITA graft; and one (6.25%) patient sequential SVG and LITA graft. One of the proximal anastomoses was performed on the SVG in four patients (25%) and on the LITA graft in one patient (6.2%). One patient (6.2%) died due to cerebrovascular morbidity. No other complications were observed. CONCLUSIONS The innominate artery is an alternative site for proximal anastomoses in patients with calcific atheromatous aorta.
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Affiliation(s)
- Ibrahim Uyar
- Department of Cardiovascular Surgery, JFK Hospital, Istanbul, Turkey
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12
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Kaya E, Yerebakan H, Spielman D, Isik O, Yakut C. Simultaneous beating heart coronary artery bypass surgery and modified radical mastectomy. Heart Surg Forum 2013; 16:E116-7. [PMID: 23625477 DOI: 10.1532/hsf98.20121094] [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] [Indexed: 11/20/2022]
Abstract
Concomitant surgeries for unrelated diseases can be performed to minimize the risks associated with surgery and general anesthesia. In treating a male patient with breast cancer and severe coronary artery disease, we used the beating heart technique for a coronary artery bypass graft to avoid the negative effects of on-pump bypass on the possible acceleration of tumor growth. In this report, we present a unique case of concomitant off-pump coronary artery bypass graft surgery and modified radical mastectomy in a 56-year-old man.
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Affiliation(s)
- Erhan Kaya
- Ozel Pendik Bolge Hastanesi, Istanbul, Turkey
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Isik O, Temel O, Celik A, Sari T, Onbasioglu SU. Investigation of different wall profiles on energy consumption and baking time in domestic ovens. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20134501044] [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: 11/15/2022] Open
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Sari T, Celik A, Isik O, Temel O, Onbasioglu S. Effects of insulation parameters on the energy consumption in domestic ovens and the most efficient insulation design. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20134501019] [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: 11/14/2022] Open
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Ozturk E, Yilmazlar A, Coskun F, Isik O, Yilmazlar T. The beneficial effects of preperitoneal catheter analgesia following colon and rectal resections: a prospective, randomized, double-blind, placebo-controlled study. Tech Coloproctol 2011; 15:331-6. [DOI: 10.1007/s10151-011-0720-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 06/28/2011] [Indexed: 10/18/2022]
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Celik S, Kirbas A, Gurer O, Yildiz Y, Isik O. Sternal dehiscence in patients with moderate and severe chronic obstructive pulmonary disease undergoing cardiac surgery: the value of supportive thorax vests. J Thorac Cardiovasc Surg 2011; 141:1398-402. [PMID: 21377699 DOI: 10.1016/j.jtcvs.2011.01.042] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 12/21/2010] [Accepted: 01/24/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Sternal dehiscence after open surgery is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease is a significant risk factor. Therefore, we aimed to determine whether moderate and severe chronic obstructive pulmonary disease had an effect on the development of sternal dehiscence and whether the use of the Robicsek technique for sternal closure along with sternal support vest postoperatively would reduce the incidence of sternal dehiscence in patients with moderate/severe chronic obstructive pulmonary disease undergoing cardiac surgery. METHODS Two studies were performed. In study 1, 842 patients undergoing cardiac surgery and figure-of-8 wire closure were retrospectively evaluated in 2 groups: group 1a (328 patients with chronic obstructive pulmonary disease) and group 1b (514 patients without chronic obstructive pulmonary disease). In study 2, 221 patients with moderate and severe COPD who were scheduled for open surgery were prospectively enrolled. The Robicsek technique was used for sternal closure. The postoperative thorax support vest was used in 100 patients (group 2a), and no additional procedure was applied in 121 patients (group 2b). RESULTS In study 1, the dehiscence rate was significantly higher in group 1a (7.9%) than in group 1b (1.2%; P < .001), and mortality rates in patients with dehiscence were 53.8% and 33.3%, respectively. In study 2, the dehiscence rate was significantly lower in group 2a (1%) than in group 2b (11.5%; P = .002). None of the patients with dehiscence in group 2a died, and 35.7% of patients died in group 2b. CONCLUSIONS The Robicsek technique for sternal closure and the use of a thorax support vest postoperatively are highly effective in preventing sternal dehiscence after cardiac surgery in patients with moderate and severe chronic obstructive pulmonary disease.
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Affiliation(s)
- Sezai Celik
- Thoracic Surgery Division, Thoracic Department, Medicana Hospitals Group, Istanbul, Turkey.
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Kirbas A, Celik S, Gurer O, Yildiz Y, Isik O. Sternal wrapping for the prevention of sternal morbidity in elderly osteoporotic patients undergoing median sternotomy. Tex Heart Inst J 2011; 38:132-136. [PMID: 21494519 PMCID: PMC3066823] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Osteoporosis, a major risk factor for sternum-related morbidity after median sternotomy, is quite prevalent among the elderly. In this prospective study, we investigated the potential of sternal protection by use of the "sternal wrapping method" in elderly osteoporotic patients who were undergoing median sternotomy.For this study, we chose 100 elderly osteoporotic patients who were scheduled to undergo median sternotomy. During surgery, we wrapped the sternal edges with polyvinyl chloride tubing in 50 patients (group 1) and omitted the sternal wrapping in the remaining 50 patients (group 2). We then compared the groups with regard to postoperative pain, bleeding, early and late sternum-related morbidity, sternal fractures, and duration of hospitalization.Sternal wrapping was associated with fewer sternal fractures, less chest pain, and shorter hospital stays. Overall sternal morbidity was significantly less common among patients with sternal wrapping (4% vs. 20%, P = 0.03); however, the difference in individual rates for early and late dehiscence or deep sternal infection did not reach statistical significance.Sternal wrapping using polyvinyl chloride tubes provides mechanical protection and, apparently, less postoperative chest pain and shorter hospitalizations. Probably, it reduces sternum-related complications, particularly in high-risk patients. Its benefits, however, should be confirmed in larger studies.
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Affiliation(s)
- Ahmet Kirbas
- Division of Cardiovascular Surgery, Medicana Hospitals Camlica, 34764 Istanbul, Turkey
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Kirbas A, Gurer O, Ugurlucan M, Yildiz Y, Karabay BC, Isik O. Mitral regurgitation secondary to anterior leaflet rupture during percutaneous balloon valvuloplasty: case report. Heart Surg Forum 2010; 13:E328-9. [PMID: 20961835 DOI: 10.1532/hsf98.20101025] [Citation(s) in RCA: 1] [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
Rheumatoid heart disease and the mitral stenosis secondary to it in the long term are still important cardiovascular problems in developing countries. Percutaneous balloon mitral valvuloplasty is a valid treatment option with low complication rates for relieving the signs and symptoms of selected patients with mitral valve stenosis. In this report, we describe subacute mitral regurgitation secondary to anterior leaflet rupture following percutaneous balloon mitral valvuloplasty and the management strategy in a 54-year-old female patient. Such a complication is rare in experienced hands in the current era.
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Affiliation(s)
- Ahmet Kirbas
- Cardiovascular Surgery Clinic, Camlica Medicana Hospital, Istanbul
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Gurer O, Kirbas A, Ugurlucan M, Isik O. Mitral valve repair in a patient with thrombocytopenia-absent radius syndrome: case report. Heart Surg Forum 2010; 13:E336-8. [PMID: 20961838 DOI: 10.1532/hsf98.20101016] [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] [Indexed: 11/20/2022]
Abstract
Thrombocyte level and functions are vital factors during cardiac surgery. Thrombocytopenia-absent radius syndrome (TAR) is a rare genetic disorder consisting of skeletal abnormalities and thrombocytopenia. In this report, we present the management strategy for a 23-year-old female patient with TAR syndrome who underwent mitral valve repair.
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Affiliation(s)
- Onur Gurer
- Camlica Medicana Hospital, CardiovascularSurgery Clinic, Alemdag Caddesi No: 85, Uskudar, Istanbul, Turkey.
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Ugurlucan M, Zencirci E, Selimoglu O, Basaran M, Ogus TN, Isik O. Pressure-regulated tepid blood reperfusion in patients undergoing emergency coronary revascularization after myocardial infarction. Asian Cardiovasc Thorac Ann 2010; 18:402-3. [PMID: 20719800 DOI: 10.1177/0218492310374777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Karabay BC, Ugurlucan M, Ziyade S, Isik O. Is the thoracic duct injury the cause of chylopericardium after cardiac surgery performed through median sternotomy? Ann Thorac Surg 2010; 90:360-1; author reply 361-2. [PMID: 20609829 DOI: 10.1016/j.athoracsur.2009.11.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 10/27/2009] [Revised: 10/27/2009] [Accepted: 11/30/2009] [Indexed: 11/20/2022]
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22
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Ugurlucan M, Selimoglu O, Ogus TN, Isik O. Aorta non-clamp technique in case of sclerotic ascending aorta during coronary artery bypass grafting. Eur J Cardiothorac Surg 2010; 38:648; author reply 648-9. [PMID: 20399110 DOI: 10.1016/j.ejcts.2010.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/02/2010] [Revised: 02/02/2010] [Accepted: 03/06/2010] [Indexed: 11/15/2022] Open
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Ugurlucan M, Basaran M, Ogus TN, Isik O. Fibrillation without cross-clamping in the pesence of sclerotic ascending aorta. Asian Cardiovasc Thorac Ann 2010; 18:94-5. [PMID: 20124310 DOI: 10.1177/0218492309355490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Mataraci I, Polat A, Kıran B, C̨alışkan A, Tuncer A, Erentug V, Kirali K, Isik O, Yakut C. Long-Term Results of Aortic Root Replacement: 15 Years' Experience. Ann Thorac Surg 2009; 87:1783-8. [DOI: 10.1016/j.athoracsur.2009.03.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 03/14/2009] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
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25
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Eren E, Bozbuga N, Toker ME, Keles C, Rabus MB, Yildirim O, Guler M, Balkanay M, Isik O, Yakut C. Surgical treatment of post-infarction left ventricular pseudoaneurysm: a two-decade experience. Tex Heart Inst J 2007; 34:47-51. [PMID: 17420793 PMCID: PMC1847932] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Herein, we present a retrospective analysis of our experience with acquired pseudoaneurysms of the left ventricle over a 20-year period.From February 1985 through September 2004, 14 patients underwent operation for left ventricular pseudoaneurysm in our clinic. All pseudoaneurysms (12 chronic, 2 acute) were caused by myocardial infarction. The mean interval between myocardial infarction and diagnosis of pseudoaneurysm was 7 months (range, 1-11 mo). The pseudoaneurysm was located in the inferior or posterolateral wall in 11 of 14 patients (78.6%). In all patients, the pseudoaneurysm was resected and the ventricular wall defect was closed with direct suture (6 patients) or a patch (8 patients). Most patients had 3-vessel coronary artery disease. Coronary artery bypass grafting was performed in all patients. Five patients died (postoperative mortality rate, 35.7%) after repair of a pseudoaneurysm (post-infarction, 2 patients; chronic, 3 patients). Two patients died during follow-up (median, 42 mo), due to cancer in 1 patient and sudden death in the other. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients. Surgical repair is warranted particularly in cases of large or expanding pseudoaneurysms because of the propensity for fatal rupture.
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Affiliation(s)
- Ercan Eren
- Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, 34718 Istanbul, Turkey.
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Erentug V, Bozbuga N, Kirali K, Goksedef D, Akinci E, Isik O, Yakut C. Surgical treatment of subaortic obstruction in adolescent and adults: long-term follow-up. J Card Surg 2005; 20:16-21. [PMID: 15673405 DOI: 10.1111/j.0886-0440.2005.200336.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [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: 11/30/2022]
Abstract
Subaortic stenosis (SAS) is a wide spectrum of anatomical derangements ranging from a discrete fibrous membrane to tortuous fibrous tunnel with or without aortic annulus hypoplasia. We have reviewed 88 patients undergoing surgery for SAS over a 15-year period. There were 47 male and 41 female patients with a mean age of 19.8 +/- 10.6 years (range 11 to 39). Fifty-eight patients had discrete subaortic membrane, and 30 patients had diffuse tunnel subvalvular stenosis. The mean systolic pressure gradients were found to be 86.5 +/- 31.4 mmHg (range 48 to 145 mmHg). Ten patients had mild and 13 patients had moderate-to-severe aortic insufficiency (AI) preoperatively. Nine patients had bicuspid aortic valve. Forty patients (45.4%) had associated cardiac lesions. Isolated membranectomy was performed in six patients. Membranectomy associated with septal myectomy was done in 52 patients. Fifteen patients of them associated hypoplasia of the aortic orifice necessitated aortic valve replacement (AVR) using the Konno-Rastan procedure. Fifteen patients with tunnel SAS and normal aortic valves underwent a combined approach for valve sparing, a modified Konno procedure with patch septoplasty. Also eight patients required AVR because of the severity of AI and five patients aortic reconstruction procedures. Aortic commissurotomy was performed to relief of stenosis in four patients. There were three early deaths (3.4%) and one late death (1.1%) all after the Konno-Rastan procedure. Eight patients (9.1%) had permanent conduction abnormalities. Postoperative left ventricle-aorta gradient was significantly decreased at early postoperative period (p < 0.001) and ranged from 10 to 25 mmHg (mean 14.1 +/- 4.3). Fourteen patients (16.5%) were reoperated for recurrent obstruction or progression of AI. The mean reoperation interval was 4.4 +/- 1.7 years (range 2 to 8 years). Five-year reoperation-free survival was 88.0 +/- 3.6% and 12.5-year reoperation-free survival was 75.5 +/- 7.0%. Our results of aggressive surgical approach of subvalvular aortic stenosis produces relief of obstruction and frees the valve leaflets, significantly reducing associated AI with long-term survival and long-term adequate relief of left ventricular outflow tract obstruction.
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Affiliation(s)
- Vedat Erentug
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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Bozbuga N, Erentug V, Kirali K, Akinci E, Isik O, Yakut C. Midterm results of aortic valve repair with the pericardial cusp extension technique in rheumatic valve disease. Ann Thorac Surg 2004; 77:1272-6. [PMID: 15063250 DOI: 10.1016/j.athoracsur.2003.09.087] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND The encouraging results of valve repair in the atrioventricular valves have influenced a decision about aortic valve (AV) reconstruction. We report our experience with pericardial cusp extension to repair rheumatic AV disease. METHODS From 1993 to 1998, 46 patients (25 women, 21 men) with a mean age of 31.5 +/- 12.2 years (range, 15 to 58 years) underwent AV repair. Twenty-two (47.8%) patients had moderate and 24 (52.2%) had severe aortic insufficiency (AI). Severe cusp retraction was repaired with glutaraldehyde-treated autologous pericardium. Twenty-one patients had more than one maneuver (mean, 1.8) to attain competence besides augmentation, which consisted of the release of stenotic commissures (in 11 cases), thinning of the AV cusps (in 10 cases), and resuspension of the cusps (in 17 cases). Simultaneous mitral valve repair was performed on 17 patients. Eight patients received triple valve reconstruction. RESULTS There was no early mortality. Thirty patients no longer had AI with any significant transvalvular gradients. Five patients were followed with mild residual AI, and 2 patients with moderate AI not requiring reoperation. Nine patients developing severe AI required AV replacement with a reoperation rate 19.6% (4.26%/patient-year). The mean interval between repair and reoperation was 28.2 +/- 18.3 months (range, 3 to 58 months). The mean observation time was 4.6 +/- 3 years (211.6 patient-years). Late mortality rate was 2.2% with 1 patient. The significant negative predictors of aortic reoperation determined by univariate analysis were preoperative New York Heart Association class (p = 0.002) and postoperative severe AI (p < 0.001). Cox hazard studies identified that all risk factors were insignificant for aortic reoperation. The actuarial rate of freedom from aortic reoperation was 76.1% +/- 7% at 7.5 years. CONCLUSIONS Although AV repair by extension with pericardium is worth considering with an acceptable solution to achieve a good geometry from unequal cusps, especially in young rheumatic patients for preservation of the native AV, the patients should be followed periodically for reoperation risk.
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Affiliation(s)
- Nilgün Bozbuga
- Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
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28
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Omeroglu SN, Kirali K, Mansuroglu D, Goksedef D, Balkanay M, Ipek G, Isik O, Yakut C. Is posterior leaflet extension and associated commissurotomy effective in rheumatic mitral valve disease? Long-term outcome. Tex Heart Inst J 2004; 31:240-5. [PMID: 15562843 PMCID: PMC521763] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In this prospective study, the long-term effect of posterior leaflet extension with glutaraldehyde-preserved autologous pericardium and associated mitral valve commissurotomy was investigated in patients with mixed mitral valve disease of rheumatic origin. Mitral commissurotomy and posterior leaflet extension using a pericardial patch were performed in 25 patients from 1 January 1994 through 31 December 1995 for mixed mitral valve disease. Preoperatively, no patient had chordal rupture or papillary muscle dysfunction. Four patients had left atrial thrombosis. The mean age was 35.7 +/- 15.4 years. Associated procedures were tricuspid annuloplasty in 4 patients, aortic annuloplasty in 3, aortic and tricuspid annuloplasty in 1, and aortic homograft replacement in 1. There were no early deaths. One patient died 2 years after surgery due to noncardiac causes. Mitral valve area increased from 1.53 +/- 0.63 cm2 to 2 +/- 0.33 cm2 (P = 0. 09), and left atrial diameter decreased from 5.8 +/- 1 cm to 4.86 +/- 1.27 cm (P = 0.07) after 6.1 +/- 0.7 years (range, 5.5 to 71 years). Mitral insufficiency was reduced significantly, from grade 2.65 +/- 0.9 to grade 1.2 +/- 0.9 (P = 0.007). Functional capacity improved in all patients (New York Heart Association functional class, 3 +/- 0.58 preoperatively vs 1.44 +/- 0.82 postoperatively; P = 0.001). Three patients required reoperation and valve replacement. This type of reconstruction may be a good alternative for patients who are not able to use anticoagulant therapy. Long-term results of this technique are acceptable; however, the risk of reoperation is an important disadvantage in these young patients.
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Affiliation(s)
- Suat Nail Omeroglu
- Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Turkey.
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29
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Ogus NT, Us MH, Ogus H, Isik O. Coronary artery bypass grafting alone for advanced ischemic left ventricular dysfunction with significant mitral regurgitation: early and midterm outcomes in a small series. Tex Heart Inst J 2004; 31:143-8. [PMID: 15212124 PMCID: PMC427373] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
In 31 consecutive patients with ischemic left ventricular dysfunction and mitral regurgitation ranging from 2/4 to 3/4 (mean, 2.87 +/- 0.34), we performed coronary bypass grafting alone and assessed early and midterm outcomes. Our patients' mean preoperative New York Heart Association functional class was 3.64 +/- 0.48, and their mean left ventricular ejection fraction was 0.25 +/- 0.05. Preoperative thallium imaging revealed that all patients had at minimum a partially reversible defect in the anterior wall. All patients survived the operation. Hospital length of stay ranged from 5 to 21 days (mean, 8.35 +/- 4.07 days), and mean length of follow-up was 21.35 +/- 13.24 months. Postoperatively, patients' functional classification improved to a mean of 1.32 +/- 0.6; left ventricular ejection fraction improved to a mean of 0.43 +/- 0.09; and severity of mitral regurgitation decreased to a mean of 1.35 +/- 0.96. Statistical analysis showed that all improvements were significant. Five late cardiac deaths occurred. Preoperative variables showed no correlation with late death. However, postoperative left ventricular ejection fraction and mitral regurgitation did correlate with late death, which suggests that the reversibility of damaged ischemic myocardium plays an important role after revascularization. This study supports the concept that ischemic mitral regurgitation might well improve after myocardial revascularization regardless of its severity; therefore, it should not be corrected at the primary operation, except in patients with organic valvular changes.
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Affiliation(s)
- Noyan Temucin Ogus
- Cardiovascular Surgery Department, Maltepe University, Maltepe-Istanbul, Turkey
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30
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Ogus NT, Ciçek S, Isik O. Selective management of high risk patients with an ascending aortic dilatation during aortic valve replacement. J Cardiovasc Surg (Torino) 2002; 43:609-15. [PMID: 12386571] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND The ascending aortic dilatation secondary to aortic valve disease may be a risk for rupture or dissection unless it is not corrected with a graft replacement during valve surgery. This additional procedure requires prolonged operation time that can be harmful for the critical patient. External reinforcement of diseased aorta is an old but simple method with debated long term results, providing brief duration and lower complication rate of the aneurysm operation for critically ill patients whose life expectancy is poor. METHODS Twenty-two patients underwent aortic valve replacement and external aortic wrapping procedure in our clinic. All of the patients had severe associated risk factors to complicate the classical aortic graft replacement procedure. In this prospective clinical study, the follow-up period of the patients is 79.91 patient-years. RESULTS There was no operative mortality. The average hospital stay was 8.6+/-2.6 days. There was no late death or cardiac morbidity. All of the patients were in NYHA Class 1 at postoperative 3rd month and thereafter. In CT scans the mean preoperative ascending aortic diameter was 5.12+/-0.38 cm while the mean diameter at 3rd month postoperatively was 3.19+/-0.25 cm. The reduction in diameter showed a significant difference (p<0.0001). The time related changes in luminal diameters showed some enlargement within the first year of the operation (p=0.03) that remained the same thereafter. CONCLUSIONS The early results and 4 years follow-up suggest that the technique can be regarded as safe and effective in selected high risk patients.
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Affiliation(s)
- N T Ogus
- Department of Cardiovascular Surgery, Maltepe University Faculty of Medicine, Istanbul, Turkey.
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31
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Ogus TN, Hulusi Us M, Ciçek S, Ozkan S, Yüksel Oztürk O, Isik O. Sternal cyanoacrylate gluing in mediastinitis. Effects on infection, stability and bone healing. J Cardiovasc Surg (Torino) 2002; 43:741-6. [PMID: 12386595] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND It is crucial to determine stability, histocompatibility and antibacterial properties of the cyanoacrylate used for sternal fixation. METHODS Clinical study: in 17 cases of mediastinitis, debridement and rewiring the sternum, was applied as the treatment method (Group I). Eighteen cases of mediastinitis were treated with the same method added sternal cyanoacrylate gluing (Group II). A comparative study was done; the follow-up period was 36.7+/-4 and 18.5+/-6.9 months in Group I and II, respectively. Animal study: in 10 rats, upper sternotomy was done and the sternal bone was contaminated. Direct wound closure was done in 4 rats (Group A), in 6 animals, wounds were closed after applying cyanoacrylate in sternal split (Group B). In this prospective study, all rats alive were sacrificed at the 3rd and 8th weeks and sternums were examined histologically. RESULTS Clinical study: in Group I, 6 patients required additional interventions due to recurrent sternal detachment and osteomyelitis (35.3%). In Group II neither osteomyelitis nor sternal detachment occurred, 3 patients required re-intervention related to cyanoacrylate histotoxicity. Hospital stay was higher in Group I than Group II (24.06+/-4.7 vs 14.16+/-3.98 days, respectively). Experimental study: all of the animals in Group A died of sepsis. In Group B all rats survived the procedure. At the 3rd week histologic evaluations showed that cyanoacrylate was not degraded, and no infection or foreign body reaction was observed. At the 8th week histologic examination showed that cyanoacrylate was completely degraded and replaced by connective tissue. CONCLUSIONS Cyanoacrylate is effective in diminishing sternal wound complications and related cost and hospital stay of mediastinitis.
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Affiliation(s)
- T N Ogus
- Department of Cardiovascular Surgery, Maltepe University, Faculty of Medicine, Istanbul, Turkey.
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Demirag M, Kirali K, Omeroglu SN, Mansuroglu D, Akinci E, Ipek G, Berki T, Gürbüz A, Isik O, Yakut C. Mechanical versus biological valve prosthesis in the mitral position: a 10-year follow up of St. Jude Medical and Biocor valves. J Heart Valve Dis 2001; 10:78-83. [PMID: 11206772] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY During the past 30 years, the development of mechanical and biological valves has led to major improvements in patient survival. Here, we present long-term results obtained with both types of prosthesis. METHODS At our institution, between 1985 and 1989, 158 patients received a Biocor porcine bioprosthesis, and 100 patients a St. Jude Medical (SJM) mechanical valve. Preoperatively, mean age, male:female ratio, NYHA functional class and pathology of mitral valve disease were similar in both groups. RESULTS The 30-day mortality was 4.4% in the Biocor group and 4% in the SJM group, the major cause being congestive heart failure. Late mortality was 17.9% and 15.6% respectively in the two groups, but valve-related mortality was very low in both (1.3% versus 4.2%). Ten-year survival was similar in each group (77.8+/-3.4% versus 81.0+/-3.9%; p = 0.538). Ten-year freedom from anticoagulant-related hemorrhage was higher with Biocor prostheses (99.3+/-0.7% versus 90.9+/-3.1%; p = 0.007). Valve thrombosis was seen only in the SJM group, and structural valve degeneration (SVD) only in the Biocor group. Ten-year freedom from reoperation was lower in the Biocor group (84.9+/-3.2% versus 92.2+/-2.8%; p = 0.206). The significant causes of reoperation were SVD in the Biocor group and valve thrombosis in the SJM group. Freedom from prosthetic valve endocarditis was similar in both groups (96.3+/-1.6% versus 95.5+/-2.2%). CONCLUSION As no difference was seen in survival and reoperation rates between patients receiving either bioprostheses or mechanical valves, the valve used will depend on the surgeon's choice and the type of patient, notably elderly patients who are intolerant of anticoagulation, and young women wishing to have children.
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Affiliation(s)
- M Demirag
- Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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33
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Kirali K, Güler M, Daglar B, Yakut N, Mansuroglu D, Balkanay M, Berki T, Gürbüz A, Isik O, Yakut C. Surgical repair in ruptured congenital sinus of Valsalva aneurysms: a 13-year experience. J Heart Valve Dis 1999; 8:424-9. [PMID: 10461243] [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] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Rupture of congenital sinus of Valsalva aneurysm is a rare cardiac malformation that usually causes reduced cardiac performance. METHODS Twenty patients (mean age 28.3 +/- 10.7 years; range: 14 to 55 years) with rupture of congenital sinus of Valsalva aneurysm were operated on at our institution between January 1985 and March 1999. The origin of the ruptured aneurysms was the right coronary sinus in 18 patients (90%) and the non-coronary sinus in two (10%). No ruptures were observed originating from the left coronary sinus. The aneurysms ruptured into the right ventricle in 14 patients (70%), into the right atrium in five (25%), and into the left ventricle in one patient (5%). Subarterial ventricular septal defect (VSD) was the most common associated defect (30%), and aortic insufficiency the second (20%). No correlation was found between subarterial VSDs and aortic insufficiency (p > 0.05). To achieve repair, the aorta and cavity into which the aneurysm had ruptured were opened. The aneurysmal sac was excised and the defect closed with a patch in 18 patients, and without patch in two. RESULTS One patient died in hospital (mortality rate 5%); no late mortality was observed. Surviving patients were followed up for 4.4 +/- 3.3 years (range: 1 to 13 years). The actuarial survival rate was 95% at 12.35 years. Recurrence of fistula was observed in one patient (5%) in whom the ruptured aneurysm had been closed by primary suture without the use of a patch. At 12.35 years, the actuarial freedom from recurrence of fistula was 94.74% for all survivors, and 100% for patients with patch closure. No late complications have been observed. CONCLUSIONS Following diagnosis of ruptured sinus of Valsalva aneurysm, surgical repair is the treatment of choice. Surgery performed as rapidly as possible after diagnosis in general leads to an excellent outcome.
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Affiliation(s)
- K Kirali
- Kosuyolu Heart and Research Hospital, Istanbul, Turkey
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Oğuz M, Ersoy G, Göze F, Isik O. Gastrocolic fistula due to gastric cancer (a case report). Mater Med Pol 1992; 24:55-6. [PMID: 1308273] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastrocolic fistula originating from gastric cancer is a rare complication. Allison [1] collected 233 reports on patients with fistulas due to malignant tumours of the stomach and colon. In this article, a patient suffering from gastrocolic fistula as a complication of gastric carcinoma is presented.
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Affiliation(s)
- M Oğuz
- Cumhuriyet University, Sivas, Turkey
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35
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Gultekin A, Turkey S, Isik O. Intestinal obstruction due to Henoch-Schonlein purpura. Indian Pediatr 1989; 26:72-4. [PMID: 2759696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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