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Biçer M, Kehlibar T, Elibol A, Günay R, Kozan Ş, Ceylan L, Yılmaz M, Ketenci B. Comparison of Pericardial and Prosthetic Rings for Mitral Repair: Are Pericardial Rings Durable in the Mid- to Long-Term Follow Up? Heart Surg Forum 2023; 26:E088-E094. [PMID: 36856493 DOI: 10.1532/hsf.5311] [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: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 02/27/2023]
Abstract
BACKGROUND While prosthetic rings are commonly used for mitral valve repairs, autologous pericardium is an alternative ring material that can be used in these procedures. In this report, we aim to present a comparison of two types of rings used for mitral repair. METHODS Between January 2005 and January 2009, 107 patients who underwent mitral valve repair surgery were analyzed. Patients were divided into two groups, according to the type of ring that was used for mitral annular stabilization. Glutaraldehyde-treated pericardial rings were used for 31 patients (group 1), whereas prosthetic rings were used for 76 patients (group 2). Survival, freedom from reoperation, recurrent mitral regurgitation, and the effects of rheumatic mitral disease on these parameters were evaluated and compared for both groups. RESULTS Follow-up time for our cohort was 4.24±0.4 years. There were four and seven late mortalities in groups 1 and 2, respectively, and five reoperations in each group. There was no significant difference between the groups, in terms of survival, freedom from reoperation, and recurrent mitral regurgitation (log-rank analyses for both groups were P = 0.777, P = 0.346, and P = 0.781, respectively). There was no significant difference in freedom from reoperation and recurrent mitral regurgitation for both groups, in terms of underlying rheumatic valvular disease and other types of pathology. CONCLUSION Pericardial ring annuloplasty shows to be a considerable alternative technique for mitral valve repair procedures in the mid- to long-term follow up. Rheumatic mitral valves had poor outcomes, when compared with other types of structural valvular pathologies in cases where pericardial rings were used in the repair procedure.
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Affiliation(s)
- Mehmet Biçer
- Department of Pediatric Cardiovascular Surgery, Koç University Hospital, Istanbul, Turkey.
| | - Tamer Kehlibar
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Ahmet Elibol
- Department of Cardiovascular Surgery, Başakşehir Çam Sakura City Hospital, Istanbul, Turkey.
| | - Rafet Günay
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Şima Kozan
- School of Medicine, Koç University, Istanbul, Turkey.
| | - Levent Ceylan
- Department of Cardiovascular Surgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Yılmaz
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
| | - Bulend Ketenci
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
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Abstract
OBJECTIVES Postoperative dyspnea is common after cardiac surgery, even in low-risk patients. Cardiac surgeons and anesthesiologists are familiar with patients suffering from dyspnea in the early postoperative period, but in some cases, conventional treatment strategies may be ineffective, and a consultation with a pulmonologist may be required. The aim of this study is to investigate the causes of dyspnea after cardiac surgery in this particular patient group. MATERIALS AND METHODS The hospital database was searched for non-emergency cardiac surgery for the period January 2014-October 2015. Individuals with an impaired spirometry result and a history of any pulmonic disease were excluded. Only patients for whom a pulmonary consultation was needed because of dyspnea in the postoperative course were enrolled in the study. Causes of dyspnea were analyzed according to consultation reports and computed tomography findings. RESULTS One hundred and three patients were enrolled in the study. Of those, 67 (65%) were male, and the mean age was 61.50±9.43. The most common procedure was the coronary artery bypass grafting. Atelectasis (n=57, 42%) was the most common cause of dyspnea. The length of the intensive care unit (ICU) stay was significantly longer in the pneumonia group (p=0.012). Hospital mortality in the pneumonia group was significantly higher compared with other subgroups (p<0.001). CONCLUSION After cardiac surgery, atelectasis was the most common cause of dyspnea, followed by pleural effusion and pneumonia. Patients who experienced dyspnea due to pneumonia had a longer ICU stay. Developing the treatment strategies with consideration of these causes may help reduce the length of stay, morbidity, and mortality in this patient group.
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Affiliation(s)
- Ahmet Bolukçu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sami İlhan
- Clinic of Pulmonology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Can Topçu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Rafet Günay
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - İlyas Kayacıoğlu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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İlhan S, Bolukçu A, Günay R, Topçu AC. Right Sided Aortic Arch Resembling Asthma. Turk Thorac J 2016; 17:160-162. [PMID: 29404147 DOI: 10.5578/ttj.30514] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/04/2015] [Indexed: 11/15/2022]
Abstract
Exertional dyspnoea and shortness of breath at rest are common complaints in asthmatic patients. However, symptoms sometimes do not resolve under optimal medical treatment. In such cases infrequent causes of dyspnoea may be the underlying basis. We present a 38-year-old patient who suffered from shortness of breath not amenable to medical treatment for asthma for five years. In her medical history, the patient was on salbutamol inhalation as well as budesonide/formoterol inhalation for 5 years and the symptoms did not ameliorate. We diagnosed a right sided aortic arch after investigations. In this rare anomaly, both trachea and oesophagus might be encircled and compressed by large vessels as well as the aortic arch. Although some signs of right sided aortic arch can be recognized in chest radiograph and spirometry, accurate diagnosis is made by contrast enhanced computed tomography or angiography. Delay in diagnosis of right sided aortic arch may result in unnecessary investigations and prolonged periods of ineffective treatment. Diagnosis of right sided aortic arch leads to improvement in symptoms and withdrawal of unnecessary treatment.
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Affiliation(s)
- Sami İlhan
- Clinic of Chest Diseases, Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Bolukçu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Rafet Günay
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Can Topçu
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Chest and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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İlhan S, Günay R, Özkan S, Güvenç TS, Yurtsever N. Arterial Blood Gas Analysis in Chronic Obstructive Pulmonary Disease Patients Undergoing Coronary Artery Bypass Surgery. Turk Thorac J 2016; 17:93-99. [PMID: 29404133 DOI: 10.5578/ttj.30503] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/20/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We aimed to investigate the impact of arterial blood gas (ABG) on morbidity and mortality in chronic obstructive pulmonary disease (COPD) patients undergoing CABG surgery. MATERIAL AND METHODS The records for 75 COPD patients who underwent elective CABG surgery our institution clinic between November 2008 to 2011 and had a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ≤ 70% value in the pulmonary function tests (PFT) performed prior to the surgery were evaluated retrospectively. COPD patients were divided into two groups; Group 1; FEV1 ≥ 60% and Group 2; FEV1 ≤ 59%. Groups were compared for mortality and adverse events after identification of other preoperative and postoperative factors that could affect mortality and adverse events. An ABG was obtained immediately before and 3 to 6 hours after surgery to study the predictive value of ABG in seperate COPD groups. RESULTS There were no significant differences in patients with high partial pressure carbondioxide (PaCO2) preoperative values compared to patients with normal values. Also there were no significant differences in patients with lower partial pressure of oxygen (PaO2) preoperative values compared to patients with normal values in terms of mortality. Postoperative myocardial infarction (MI) was significantly higher in patients with low PaO2 values (p< 0.05). CONCLUSION In conclusion, in our study, there could not be found a relation between the degree of preoperative obstruction and mortality for COPD patients who underwent CABG surgery. ABG was not found useful for predicting mortality in COPD patients undergoing CABG surgery, but could be useful to predict postoperative MI in patients with COPD.
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Affiliation(s)
- Sami İlhan
- Clinic of Chest Diseases, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Rafet Günay
- Clinic of Cardiovascular Surgery, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Reseacrh Hospital, İstanbul, Turkey
| | - Sevil Özkan
- Clinic of Internal Medicine, Haydarpaşa Numune Training and Reseacrh Hospital, İstanbul, Turkey
| | - Tolga Sinan Güvenç
- Clinic of Cardiology, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nurgül Yurtsever
- Clinic of Anesthesiology, Dr. Siyami Ersek Chest Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Abstract
In cardiovascular and thoracic surgery, troublesome bleeding and sternal dehiscence can be life-threatening if not managed appropriately. We used commercially available cyanoacrylate adhesive 21 times in 20 sporadic patients for the management of 6 different problems: sternal gluing in 7 cases; anastomotic line reinforcement and bleeding control with a glued Teflon or pericardial patch in 6; right ventricular or superior vena caval patch repair in 5; and 1 case each of left ventricular apical glued Teflon felt, arterial wall reinforcement, and control of air leakage after lung surgery. The mean age of the patients was 55.7 ± 12.5 years, ranging from 34 to 71 years. Successful results were obtained in 18 patients and 17 were alive on follow-up at 7.7 ± 5.5 months (range, 2 to 16 months). We used two different commercial brands of adhesive but obtained good results with only one of these preparations. Although commercially available cyanoacrylate is a new adjunct to cardiac surgery with documented safety and lifesaving results at negligible cost, the appropriate polymer for best results needs to be defined.
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Affiliation(s)
- M Murat Demirtaş
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Serdar Cimen
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Bülend Ketenci
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Rafet Günay
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Murat Akçar
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
| | - Azmi Özler
- Siyami Ersek Thoracic & Cardiovascular Surgery Center Istanbul, Turkey
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Abay G, Kocaaslan C, Günay R, Doğan M, Demirtaş MM. Recurrent Left Atrial Botyroid Rhabdomyosarcoma. Heart Surg Forum 2016; 19:E097-8. [PMID: 27355140 DOI: 10.1532/hsf.1418] [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: 09/30/2015] [Revised: 12/15/2015] [Accepted: 03/01/2016] [Indexed: 11/20/2022]
Abstract
Primary heart tumors are extremely rare and their frequency ranges from approximately 0.01-0.3% in autopsy series. Nearly one quarter of all primary cardiac tumors are malignant tumors such as sarcoma. Rhabdomyosarcoma is the second most common malignant primary tumor of the heart following angiosarcoma.Primary cardiac tumors present with one or more of the symptoms of the classic triad: cardiac symptoms and signs resulting from intracardiac obstruction; signs of systemic embolization; and systemic or constitutional symptoms. The prognosis after surgery is usually excellent in case of benign tumors, but is unfortunately still limited in localized malignant diseases [Butany 2005].In this case report we present a 45-year-old female patient operated three times in 9 years because of left atrial tumor.
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Affiliation(s)
- Günseli Abay
- Department of Anesthesiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Cemal Kocaaslan
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Rafet Günay
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
| | - Meryem Doğan
- Pathology Department, Haydarpasa Numune Hospital, Istanbul, Turkey
| | - Mahmut Murat Demirtaş
- Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
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Memetoglu ME, Kehlibar T, Yılmaz M, Günay R, Arslan Y, Tuygun A, Kocaaslan C, Çoskun G, Ketenci B, Güney MR, Demirtas M. Serum uric acid level predicts new-onset atrial fibrillation after coronary artery bypass graft operation. Eur Rev Med Pharmacol Sci 2015; 19:784-789. [PMID: 25807430] [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: 06/04/2023]
Abstract
OBJECTIVE To investigate the association between serum uric acid levels and the risk of incident atrial fibrillation in patients after coronary artery bypass graft (cABG) operation. PATIENTS AND METHODS A total of 174 patients undergoing nonemergency coronary artery bypass graft operation were included in the study. Patients with previous atrial arrhythmia or requiring concomitant valve surgery were excluded. We prospectively analyzed 174 patients (mean age: 59.8 years; 109 male and 65 female). The serum uric acid level was determined preoperatively. RESULTS After a coronary artery bypass graft operation operation, 35 (20%) patients developed atrial fibrillation. Preoperative uric acid levels were significantly higher in patients who developed atrial fibrillation than in those who did not (7.8 ± 1.1 vs 5 ± 0.9). Using a cutpoint of 6.55, the preoperative level correlated with the appearance of atrial fibrillation with a sensitivity of 91.4% and specificity of 84.2%. CONCLUSIONS Serum uric acid level can increase the sensitivity and specificity in predicting atrial fibrillation in patients after CABG operation.
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Affiliation(s)
- M E Memetoglu
- Cardiovascular Surgery Department, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Hospital, Istanbul, Turkey.
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Memetoğlu ME, Kutlu R, Memetoğlu ÖG, Kehlibar T, Yılmaz M, Günay R, Ketenci B, Güney MR, Demirtaş MM, Özel D. The evaluation of mean platelet volume levels in patients with primary and secondary Raynaud’s Phenomenon. RusOMJ 2014. [DOI: 10.15275/rusomj.2014.0101] [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: 11/09/2022] Open
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Tuygun AK, Ketenci B, Günay R, Görür A, Güney MR, Biçer M, Tuygun A, Ozay B, Cimen S, Demirtaş M, Yekeler I. Validity and reliability of VEINES-QOL/Sym questionnaire in chronic venous disorders. J Cardiovasc Surg (Torino) 2012; 53:355-361. [PMID: 22269893] [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: 05/31/2023]
Abstract
AIM The aim of this study was to translate the VEINES-QOL/Sym questionnaire into Turkish, which is used mainly in Western European countries, and to study its reliability and validity. METHODS Standard "forward-backward" translation method was used to translate the questionnaire. The internal consistency was assessed with Cronbach's α, test-retest reliability was assessed with the intraclass correlation and Spearman-Brown coefficients. Validity was examined by correlation of VEINES-QOL/Sym with SF-36, Venous Clinical Severity (VCSS), and Venous Disability Scores (VDS). RESULTS Out of 100 patients included (mean age 41.9 ± 12.5 years; 32% male, 68% female), 30 were given the questionnaire twice with 24-hour intervals for test-retest; a final completion rate of 99.2% was achieved. The Cronbach's α was 0.914. The Spearman-Brown coefficients and the intraclass correlation coefficients were 0.994, 0.988 and 0.966, 0.933 for VQOL and VSym scores, respectively. For the total quality of life and for several domains the correlations between VEINES-QOL/Sym and SF-36 were high, and significant. Inverse and significant correlations were observed with VCSS. CONCLUSION Conclusively, the Turkish version of VEINSES-QOL/Sym questionnaire is reliable and valid; thus, it is highly recommended to use Turkish version of VEINSES-QOL/Sym to evaluate the quality of life and symptoms of patients with venous insufficiency in Turkey.
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Affiliation(s)
- A K Tuygun
- Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
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Tuygun AK, Tuygun A, Yurtseven N, Şensöz Y, Günay R, Keser M, Tuygun UH, Ketenci B, Şahin S, Yekeler I. Asymmetric Dimethylarginine Levels in Buerger’s Disease. Ann Vasc Surg 2011; 25:547-54. [DOI: 10.1016/j.avsg.2010.12.011] [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] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 12/10/2010] [Accepted: 12/12/2010] [Indexed: 10/18/2022]
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Tuygun AK, Balci AY, Tuygun A, Günay R, Sensöz Y, Yurtseven N, Alkan P. Simultaneous operation in a patient with coronary heart disease, abnormal orifice of coronary arteries, morgagni hernia, atrial septal defect, and pericardial and pleural agenesis. Heart Surg Forum 2011; 13:E260-2. [PMID: 20719732 DOI: 10.1532/hsf98.20091180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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
A 68-year-old male patient with acute coronary syndrome was referred to our center. He also received a diagnosis of diaphragmatic hernia after a clinical examination. The patient underwent a simultaneous aorta coronary bypass operation and repair of the congenital diaphragm hernia. During the operation, the patient was observed to have an atrial septal defect. Our handling of the case is discussed in light of the literature.
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Cimen S, Ozkul V, Ketenci B, Yurtseven N, Günay R, Ketenci B, Gerçekoğlu H, Demirtaş M. Daily comparison of respiratory functions between on-pump and off-pump patients undergoing CABG. Eur J Cardiothorac Surg 2003; 23:589-94. [PMID: 12694781 DOI: 10.1016/s1010-7940(03)00023-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [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] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Widespread application of on-pump revascularization procedures is increasing due to the thought of elimination of untoward effects of cardiopulmonary circuit. Thus, whether off-pump coronary artery surgery eliminates side effects especially related to respiratory functions is still controversial. Although many previous studies have evaluated these respiratory functions, daily comparison of 12 parameters was not included in any of the studies. The aim of our prospective study was to ascertain whether off-pump coronary operation improves pulmonary functions and postoperative recovery period when compared with on-pump technique and whether early discharge of patients with off-pump surgery is the result of respiratory improvement. METHODS Eighteen patients in each group were included: on-pump group underwent coronary revascularization with cardiopulmonary bypass and off-pump with stabilization. Respiratory function tests and arterial blood gas analyses were performed preoperatively and daily after operation function tests included forced expiratory volume (FEV) in 1s, forced vital capacity (FVC), expiratory reserve volume, vital capacity, quotient of FEV in 1s to FVC, maximal voluntary ventilation (MVV), tidal volume, and forced midexpiratory flow. Blood gas analyses included partial arterial oxygen and carbon dioxide pressure, arterial pH and hematocrit (Hct). RESULTS Preoperative pulmonary functions and arterial blood gases were not statistically significant between groups except MVV and partial arterial oxygen pressure. MVV was slightly higher in on-pump group and partial arterial oxygen pressure was slightly lower in on-pump group. During postoperative first day Hct (P=0.004) and FEV in 1s (P=0.049) values and third day partial arterial oxygen pressure (P=0.011) and Hct (P=0.011) values were lower in on-pump group. Mean extubation, duration in postoperative suit and hospital discharge times, mean blood loss were not statistically significant between groups postoperatively. CONCLUSION Pulmonary functions and arterial blood gases were not improved in off-pump patients when compared with on-pump patients. Patients going to be surgically revascularized should not be altered to off-pump surgery merely with the hope of improving respiratory functions with off-pump technique. As the postoperative stay times at surgical theatre and hospital is not different and the extubation times were similar, early discharge of patients with off-pump surgery cannot be related merely to better preservation of respiratory functions.
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Affiliation(s)
- Serdar Cimen
- Thoracic and Cardiovascular Surgery Department, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey
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