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Öğe A comparison of three tricuspid annuloplasty techniques: Suture, ring, and band(2019) Lafçı, Gökhan; Çiçek, Ömer Faruk; Lafçı, Ayşe; Esenboğa, Kerim; Günertem, Eren; Kadiroğulları, Ersin; Çağlı, KerimBackground: This study aims to compare three different tricuspid annuloplasty techniques using suture, ring, and band. Methods: Between January 2010 and December 2015, a total of 231 consecutive patients (78 males, 153 females; mean age 50.3±15.9 years; range, 34 to 66 years) who underwent tricuspid valve annuloplasty using three different techniques were retrospectively analyzed. Tricuspid valve r epair w as p erformed w ith d e Vega a nnuloplasty t echnique (n=62, 26.8%), flexible ring (n=76, 32.9%) or Teflon strip (n=93, 40.3%). Postoperative data including vital signs, echocardiographic reports, functional status, and the rate of re-do surgeries were recorded. Results: Cardiopulmonary bypass times were statistically significantly shorter in the de Vega annuloplasty group (p<0.001). There was no significant difference among the groups in terms of the in-hospital mortality. Late postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure, and right atrial diameters showed significant improvements, compared to baseline, in ring and strip annuloplasty groups. Conclusion: Our study results demonstrate that suture-based approaches should be avoided. Instead of performing routine tricuspid ring annuloplasty, Teflon strip annuloplasty may be considered an alternative method in most cases, particularly due to controversy in selection of true ring size and high cost of this surgical material in the real-life setting.Öğe A novel suture technique for distal aorta-graft anastomosis in aortic aneurysm repair surgery: Diagonal basting stitch(Elsevier Inc., 2015) Çağlı, Kerim; Çiçek, Ömer Faruk; Lafçı, GökhanWe describe a novel suture technique of distal anastomosis between the graft and the aorta in ascending aortic aneurysm repair surgery. In this technique, the aortic graft is positioned inside the distal aortic lumen with an overlapping segment and circumferential or back wall part only diagonal basting stitches are performed without use of Teflon pledgets, strips, or bioadhesives. This new technique establishes a secure anastomosis line, shortens anastomosis time, and avoids the use of foreign materials. © 2015 Elsevier Inc.Öğe Amputasyon adayı diyabetik ayakların revaskülarizasyonu(Türk Kalp ve Damar Cerrahisi Derneği, 2013) Uzun, Hacı Alper; Diken, Adem İlkay; Hanedan, Onur; Çiçek, Ömer Faruk; Yalçınkaya, Adnan; Özsoy, Hakan; Taşoğlu, İrfan; Lafçı, GökhanAmaç: Bu çalışmada ileri evre distal periferik arter hastalığı olan amputasyon adayı diyabetik hastalarda uygulanan cerrahi distal revaskülarizasyon ile medikal tedavinin sonuçları karşılaştırıldı. Çalışma planı: Mart 2008 - Kasım 2010 tarihleri arasında diyabetik ayak ve kritik uzuv iskemisi nedeniyle kliniğimize başvuran 40 hasta prospektif olarak çalışmaya dahil edildi. Tüm hastalar Fontaine sınıf 4 olarak sınıflandırıldı. Hastaların 21’ine (ort. yaş 63.5 yıl) diz altı cerrahi revaskülarizasyon uygulanırken, 19’una (ort. yaş 67.9 yıl) medikal tedavi uygulandı. Medyan takip süresi 28 aydı (dağılım 16-47 ay). Hastaların klinik bulguları, amputasyon kayıtları ve greft açıklık oranları kaydedildi. Bulgular: Takip süresince cerrahi grubunda yedi hastada greft darlığı gözlendi. Cerrahi grubunda primer ve sekonder greft açıklık oranları sırasıyla %66.7 ve %80.9 idi. Ortalama uzuv kayıpsız geçen süre cerrahi grupta 42.3±2.7 ay iken medikal tedavi verilen hastalarda 31.5±4.1 ay idi. Ameliyat sonrası 12, 24 ve 30 aylık ekstremite korunması oranı sırasıyla %90.5, %85.7 ve %81 idi. Medikal tedavi verilen hastalarda ise 12 ve 24 aylık ekstremite korunması oranı sırasıyla %78.9 ve %52.6 olarak saptandı (p<0.05). Sonuç: Amputasyon adayı diyabetik hastalar distal yerleşimli periferik arter hastalığı mevcudiyetinde dahi cerrahi revaskülarizasyondan anlamlı fayda görebilirler. Cerrahi tedaviyle amputasyon oranları ve düzeyleri azaltılabilir ve uzuv kaybı olmadan zaman ve ekstremite kurtarma oranları artırılabilir.Öğe An alternative "no resection" technique for posterior mitral leaflet prolapse repair: Reverse T-plasty(Lippincott Williams and Wilkins, 2014) Çağlı, Kerim; Lafçı, Gökhan; Çiçek, Ömer FarukReverse T-plasty is an alternative "no resection" technique for posterior mitral leaflet prolapse repair that is inspired by butterfly resection. It combines mediolateral and anteroposterior plane foldings of the posterior leaflet without any resection and shortens cardiopulmonary bypass and cross-clamping time. Copyright © 2014 by the International Society for Minimally Invasive Cardiothoracic Surgery.Öğe Early mortality and long-term survival after repair of post-infarction ventricular septal rupture: An institutional report of experience(Elsevier Ltd, 2016) Yalçınkaya, Adnan; Lafçı, Gökhan; Diken, Adem İlkay; Aksoy, Eray; Çiçek, Ömer Faruk; Lafçı, Ayşe; Korkmaz, Kemal; Çağlı, KerimBackground: To determine predictors of mortality after surgical management of post-infarction ventricular septal rupture repair. Methods: A total of 63 patients (73.2%, mean age 67.22±7.71 years, male:female ratio; 35:28) underwent open heart surgery for post-infarction ventricular septal rupture repair. Patient demographics, operative data and postoperative parameters were analysed to reveal predictors of early mortality and long-term survival. Results: In-hospital mortality was 54.0% (34/63). Time from myocardial infarction to operation ? 14 days (OR: 4.10, 95% CI 1.16-14.46, p=0.02), systolic pulmonary artery pressure > 45 mmHg (OR: 4.14, 95% CI 1.110-15.496, p=0.03) and age (years) (OR: 1.09, 95% CI 1.002-1.194, p=0.04) were found to be independent predictors of in-hospital mortality. In multivariate Cox regression analysis, presence of pulmonary oedema on admission (HR: 4.95, 95% CI 1.58-15.54, p=0.006), age (years) (HR: 1.09, 95% CI 1.009-1.180, p= 0.02) and cross-clamp time <60 min (HR: 3.93, 95% CI 1.13-13.64, p=0.03) were found to be independent predictors of long-term survival. Within a follow-up of a median of 60.0 months, five-year survival rate was 67±9.0%. Conclusion: In line with the previous studies, our study demonstrated the benefits of delaying the repair for post-infarction ventricular septal rupture to allow adequate myocardial healing if haemodynamic status of the patient allows. © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).Öğe Effect of left atrial reduction on restoration and maintenance of sinus rhythm in patients undergoing mitral valve replacement: A pilot study(Georg Thieme Verlag, 2016) Yalçınkaya, Adnan; Diken, Adem İlkay; Aksoy, Eray; Lafçı, Gökhan; Çiçek, Ömer Faruk; Kadiroğulları, Ersin; Uluşar, Ümit Deniz; Çağlı, KerimBackground This pilot study aimed to evaluate the effectiveness of posterior left atrial wall plication (T-plasty) in patients with persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve surgery. Materials and Methods A total of 60 patients who were scheduled for mitral valve replacement were randomly allocated into two groups: one would receive (Group 1; n = 32, mean age; 49.37 ± 9.00) and one would not receive (Group 2; n = 28; mean age 48.64 ± 8.6) left atrial size reduction using T-plasty technique. Patients with a clear indication for combined procedures other than tricuspid valve disease, aortic valve disease, and coronary artery stenosis were not included. Follow-up was performed at 6th, 12th, and 18th months after the operation. Results After the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in Group 2 regained sinus rhythm (p = 0.13). Mortality did not occur. AF recurrence rates were not significantly different between the groups in three follow-ups. Restoration of sinus rhythm was significantly more common in Group 1 patients than in Group 2 patients during follow-up. Patients in Group 1 had lower left atrial volume indexes than those in Group 2 at the 6th and 12th months, whereas the difference at the 18th month was at the limit of significance. Conclusion We achieved satisfactory results using the T-plasty technique for left atrial size reduction in terms of mid-term restoration and preservation of normal sinus rhythm in patients undergoing mitral valve surgery. Further study may be justified to reveal the prognostic importance of the technique described herein. © Georg Thieme Verlag Stuttgart. New York.Öğe Groin swelling in a four-year-old boy: Primary great saphenous vein aneurysm(Elsevier Inc., 2015) Çiçek, Mustafa Cüneyt; Çiçek, Ömer Faruk; Yalçınkaya, Adnan; Taşoğlu, İrfanPrimary venous aneurysm, especially in pediatric population, is a very rare clinical entity. We report a case of primary great saphenous vein aneurysm in a 4-year-old boy. He was initially suspected of suffering from inguinal hernia because the soft mass was detected at the inguinal region when the patient was in the standing position, but color Doppler ultrasonography demonstrated the swelling to be a great saphenous vein aneurysm. We decided that surgery was the best option because of potential risk for thromboembolism. © 2015 Elsevier Inc.Öğe Long-term patency of autogenous saphenous veins vs. PTFE interposition graft for prosthetic hemodialysis access(Kare Publishing, 2014) Uzun, Hacı Alper; Diken, Adem İlkay; Yalçınkaya, Adnan; Hanedan, Onur; Çiçek, Ömer Faruk; Lafçı, Gökhan; Altıntaş, Garip; Çağlı, KerimObjective: Prosthetic vascular access is the other choice when the superficial venous system is inadequate to perform a simple radio-cephalic and brachio-cephalic fistula.Methods: This paper reports the outcomes of a prospective cohort study of 54 patients who underwent either saphenous vein (SVI Group, n=29) or PTFE graft (PTFE Group, n=25) interposition surgery for prosthetic hemodialysis access. All patients were evaluated via color Doppler ultrasonography during preoperative course and superficial venous systems of these patients were found inadequate to perform simple radial/ brachial artery-cephalic vein anastomosis. Follow-up was performed for every 6-months period. Kaplan-Meier analysis and Log Rank test was used for estimation and comparison of the patency.Results: In SVI group access failure was observed in 5 of 29 patients (17.2%). In PTFE group, access failure was observed in 13 of the 25 patients (52%). Primary patency rate was 93% in 12th month and 82% in 24th month in SVI group while it was 88% in 12th month and 56% in 24th month in PTFE group. According to the Kaplan-Meier method, mean time of primary patency was significantly higher in SVI group when compared to PTFE group (33.03±1.32 months vs. 28.16±1.91 months, Log Rank chi-square value: 7.01, df:1, p=0.008). Secondary patency rate was 96% in 12th month and 93% in 24th month for SVI group while 96% in 12th month and 84% in 24th month for PTFE group. According to the Kaplan-Meier method, mean time of secondary patency was significantly higher in SVI group when compared to PTFE group (34.27±0.95 months vs. 31.16±1.40 months, Log Rank chi-square value: 7.33, df:1, p=0.007).Conclusion: Autologous saphenous vein can be preferably chosen as a prosthetic hemodialysis access graft due its higher primary and secondary patency, lower complication rate and cost when compared with PTFE grafts. © 2014 by Turkish Society of Cardiology.Öğe Proximal occlusion of a sequential vein graft after 20 years(2015) Yalçınkaya, Adnan; Diken, Adem İlkay; Erol, Mehmet Emir; Çiçek, Ömer FarukA 67-year-old man presented with chest pain of three-month duration that occurred with moderate effort 20 years after coronary artery bypass graft surgery using the left internal mammarian artery (LIMA) to the left anterior descending artery and a sequential saphenous vein graft (SVG) to the diagonal branch and obtuse marginal artery.Öğe Relationship of admission neutrophil-to-lymphocyte ratio with in-hospital mortality in patients with acute type i aortic dissection(2014) Lafçı, Gökhan; Çiçek, Ömer Faruk; Uzun, Hacı Alper; Yalçınkaya, Adnan; Diken, Adem İlkay; Turak, Osman; Çağlı, Kumral; Taşoğlu, İrfan; Gedik, Hikmet Selçuk; Korkmaz, Kemal; Günertem, Orhan Eren; Çağlı, KerimAim: Acute aortic dissection is a life-threatening cardiovascular emergency. Neutrophil-to-lymphocyte ratio is proposed as a prognostic marker and found to be related to worse clinical outcomes in various cardiovascular diseases. Te aim of the present study was to evaluate the relationship between admission neutrophil-to-lymphocyte ratio and in-hospital mortality in acute type I aortic dissection. Materials and methods: We retrospectively evaluated 123 consecutive patients who had undergone emergent surgery for acute type I aortic dissection. Patients were divided into 2 groups as patients dying in the hospital (Group 1) and those discharged alive (Group 2). All parameters, including neutrophil-to-lymphocyte ratio, were compared between the 2 groups and predictors of mortality was estimated by using multivariate analysis. Results: A total of 104 patients (79 males, mean age: 55.2 ± 14 years) were included in the fnal analysis. In multivariate analyses, cross-clamp time, cardiopulmonary bypass time, intensive care unit duration, platelet count, and neutrophil-to-lymphocyte ratio were found to be independent predictors of mortality. Patients with higher neutrophil-to-lymphocyte ratios had a signifcantly higher mortality rate (hazard ratio: 1.05; 95% CI: 1.01-1.10; P = 0.033). Receiver operating characteristic analysis revealed that using a cut-of point of 8, neutrophil-to-lymphocyte ratio predicts mortality with a sensitivity of 70% and specifcity of 53%. Conclusion: Tis study suggests that admission neutrophil-to-lymphocyte ratio is a potential predictive parameter for determining the in-hospital mortality of acute type I aortic dissection. © TÜBİTAK.Öğe Resection of true aneurysmal arteriovenous fistulas and preserving their functions using segmental saphenous graft interposition(2013) Uzun, Hacı Alper; Çiçek, Ömer Faruk; Çiçek, Mustafa Cüneyt; Diken, Adem İlkay; Kadiroğulları, Ersin; Lafçı, Gökhan; Çağlı, KerimObjective: Arteriovenous fistulas (AVF) created for hemodialysis may be complicated by aneurysm formation. The aim of this article is to describe our experience with segmental saphenous graft interposition to treat AVF aneurysms. Material and Methods: Between June 2007 and June 2011, 23 patients who admitted to our clinic with symptoms related to single or multiple AVF aneurysms were included in the study. Under general anesthesia, the aneurysms were resected and a reverse saphenous vein graft was implanted in an end-to-end manner, after inflow and outflow of aneurysmatic fistula tract was clamped. Results: Aneurysms were secondary to brachial-cephalic fistula in 16 (69.5%) patients and radial-cephalic fistula in 7 (30.5%) patients. The mean follow-up period was 40.2±9.4 months, with a range 13 to 61 months. The saphenous vein thrombosed in 3 patients in brachial-cephalic fistula and in 3 patients in radial-cephalic fistula groups. There were no vascular complications in the remaining. Conclusion: Our results show that this method preserves AVF functions and prevents the complications of the aneurysms. Preservation techniques such as segmental saphenous graft interposition may be performed for treating functioning AVF aneurysms.Öğe Screening for left subclavian artery stenosis in patients undergoing coronary artery bypass graft surgery(Edizioni Minerva Medica, 2014) Diken, Adem İlkay; Altıntaş, Garip; Yalçınkaya, Adnan; Lafçı, Gökhan; Taşoğlu, İrfan; Tola, Muharrem; Hanedan, Onur; Çiçek, Ömer Faruk; Erkengel, İbrahim; Çağlı, KerimAim. Stenosis of the left subclavian artery may decrease the clinical benefit of the surgery and result in the coronarysubclavian steal syndrome. This study sought to evaluate the frequency of the subclavian artery stenosis via color Doppler ultrasonography (CDU) and determine the risk factors for subclavian artery stenosis. Methods. Three hundred and twenty consecutive patients who were referred for coronary artery bypass graft surgery were included in the study. All patients underwent subclavian artery color Doppler ultrasonographic evaluation while routine carotid artery examination was performed during the preoperative period. Patient characteristics including demographic, echocardiographic, operative, clinical and laboratory parameters were recorded. Results. Twenty-three of the 320 patients (7.18%) had stenosis of the left subclavian artery while 7 patients (2.18%) also had right subclavian artery stenosis. Age, dyslipidemia, chronic renal failure, peripheral artery disease (PAD), proximal right coronary artery (RCA) stenosis and carotid artery stenosis were all significantly associated with subclavian stenosis. In multivariate regression modeling; age, PAD, proximal RCA stenosis and carotid artery stenosis independently predicted subclavian stenosis. Conclusion. We recommend routine preoperative screening with CDU for those coronary artery bypass grafts patients at high risk for subclavian artery stenosis.
