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Öğe Cardiac hydatid cyst causing right ventricular outflow tract obstruction: Case report(2013) Acipayam, Mehmet; Uncu, Hasan; Altinay, Levent; Başdo?an, Faruk; Gençaslan, Murat; Özsöyler, IbrahimWe present a case of a hydatid cyst placed on the right ventricular outflow tract and applying compression on the pulmonary valve. Thirty-three years old female patient with complaints of dyspnea, palpitation and fatigue was admitted to the cardiology outpatient department. Transthoracic echocardiography revealed a septated cystic mass with the dimensions of 40X56 mm, accusing gradient on the right ventricle outflow tract, adjacent and on the same plane with the pulmonary valve, representing a hydatid cyst. Cyst resection was performed on cardiopulmonary bypass. Severe tricuspid insufficiency was observed after cyst resection. Tricuspid annuloplasty was performed using an annuloplasty ring. Because of the fatal complications of cyst rupture, in places where epidemic Echinococcus cases are seen, cardiac cysts should also be remembered, its early and correct diagnosis is of vital importance. Copyright © 2013 by Türkiye Klinikleri.Öğe A comparison of axillary blockage and local anesthesia techniques on autologous arteriovenous fistula flow rates and patient comfort in chronic hemodialysis patients(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Acipayam, Mehmet; Zor, Mustafa Hakan; Alfinay, Levent; Uncu, Hasan; Kara, Inci; Halici, UmitBackground: In this article, we aim to compare the effects of axillary nerve block and local anesthesia techniques on the flow rate and patency of arteriovenous fistulas (AVF) and postoperative early-stage pain. Methods: This prospective study included 30 patients who were scheduled for brachial artery-cephalic vein AVF construction operation between the dates June 2007 and August 2009. Group 1 (n=15) consisted of axillary nerve block, group 2 (n=15) consisted of local anesthesia administered patients. The mean age of group 1 and group 2 patients were 57.8 +/- 14.0 and 54.9 +/- 16.5 respectively. There were two patients with hypertension history in both groups. Pain scores were evaluated with visual analog scale (VAS) (0-10 cm) at 2, 6th and 24th hour after the operation. Arteriovenous fistulas patency and flow rates were measured by Doppler ultrasonography (USG) at 10th months during follow-up. Results: Postoperative pain scores of 2, 6th and 24th hour in group 1 were 1.2 +/- 0.5, 2.8 +/- 0.7 and 1.9 +/- 0.4 respectively; the same values for group 2 were 3 +/- 1.3, 3 +/- 0.7 and 2 +/- 0.5 (p=0.000; p=0.480; p=0.497). The mean flow rates measured with Doppler USG after 10 months were 966.1 +/- 206.1 ml/min in group 1 and 871.6 +/- 338.3 ml/min in group 2 (p=0.513). All the AVF were patent in group 1 and group 2. Steal syndrome arised in three patients in group 2 and none in group 1 (p=0.68). There was one patient complicated with motor blockade on the same extremity, who spontaneously recovered after 24 hours in group 1. Conclusion: We conclude that axillary blockage is an effective and safe technique in AVF construction operations which has also a positive long-term effect on AVF flow rates without any critical complication.Öğe Coronary Artery Bypass Surgery Beating Heart or Cardiopulmonary Bypass?(Int Heart Journal Assoc, 2014) Cakir, Habib; Uncu, Hasan; Gur, Ozcan; Yurekli, Ismail; Acipayam, Mehmet; Ozsoyler, IbrahimIn this study, we examined the early results for patients who underwent beating heart coronary bypass surgery and compared these results with those of conventional coronary bypass surgery. A total of 1094 patients who underwent isolated coronary artery bypass surgery between January 2009 and December 2011 in our clinic were included in this study. Seventy-three patients in whom cardiopulmonary bypass was not used (group 1) were compared to 1021 patients in whom cardiopulmonary bypass was used (group 2). The mean age was 60.7 +/- 9.3 in group 1 and 58.9 +/- 9.7 in group 2 (P > 0.05). There was no significant difference between the two groups in terms of gender, or the coexistence of diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and hypertension (P > 0.05). There was no significant difference between group 1 and group 2 in terms of development of postoperative atrial fibrillation (AF), use of an intra-aortic balloon pump, need for re-operation for bleeding, or duration of hospital stay and intensive care unit stay (P > 0.05). The need for inotropic support and the amount of mediastinal drainage were less in group 1 than in group 2 (P = 0.002, P < 0.001). The incidences of postoperative cerebrovascular accident, development of chronic renal failure, and sternal wound infection did not significantly differ between the groups (P > 0.05). There was no mortality in group 1, whereas it was calculated as 1.8% in group 2 (P = 0.63). Beating heart coronary artery bypass surgery decreases the need for inotropie support and transfusion.Öğe Early postoperative results for females undergoing isolated coronary artery bypass surgery: comparison of the pre- and postmenopausal periods(Springer, 2014) Acipayam, Mehmet; Uncu, Hasan; Altinay, Levent; Zor, Mustafa Hakan; Dogan, Pinar; Ozsoyler, IbrahimIn this retrospective study, we investigated the demographic data and evaluated our early postoperative results of premenopausal and postmenopausal females who underwent coronary artery bypass graft surgery (CABG). A total of 730 female patients who underwent CABG between April 2004 and January 2012 were included in the study. Patients were divided into two groups based on whether they were pre- (group 1) or postmenopausal (group 2). The groups were compared in terms of the demographic and peri-operative parameters. Smoking and the preoperative hematocrit levels were higher in group 1, whereas the incidence of hypertension and obesity and the European system for cardiac operative risk evaluation values were higher in group 2 (p values < 0.01; < 0.01; < 0.01; 0.004 and < 0.01 respectively). The utilization of a left internal mammary artery graft and the postoperative drainage volumes were higher in group 1; however, the number of grafts per patient, cardiopulmonary bypass duration, number of patients who needed inotropic support, blood transfusion volumes, the duration of ventilatory support and the hospital stay were higher in group 2 (p values 0.038; 0.040; 0.026; 0.032; 0.014; 0.001; < 0.01 and < 0.01, respectively). Although the mortality rates were not significantly different, postmenopausal patients require more intensive postoperative care in comparison to premenopausal patients following CABG.Öğe The effect of gender on the early results of coronary artery bypass surgery in the younger patients' group(Soc Brasil Cirurgia Cardiovasc, 2014) Uncu, Hasan; Acipayam, Mehmet; Altinay, Levent; Dogan, Pinar; Davarci, Isil; Ozsoyler, IbrahimIntroduction: In this retrospective study, we aimed to determine the risk factors for coronary artery bypass surgery in patients under 45 years of age, and evaluate the early postoperative results and the effect of gender. Methods: A total of 324 patients under 45 years of age who undergone on-pump coronary artery bypass surgery between April 12, 2004 and January 10, 2012 were included to the study. Patients divided into groups as follows: Group 1 consisted of 269 males (mean age 41.3), Group 2 consisted of 55 females (mean age 41.6). Preoperative risk factors, intraoperative and postoperative data and early mortality rates of the groups were compared. Results: Smoking rate was significantly higher in Group 1. Diabetes mellitus incidence and body mass index were significantly higher in Group 2 (P values P=0.01; P=0.0001; P=0.04 respectively). The aortic cross-clamping and cardiopulmonary bypass time and number of grafts per patient were significantly higher in Group 1 (P values P=0.04; P=0.04; P=0.002 respectively). There were no deaths in either group. Conclusion: We found that gender has no effect on early mortality rates of the coronary bypass surgery patients under 45 years.Öğe The efficacy of vitamin E in the prevention of lung ischemia-reperfusion injury after cardiopulmonary bypass in open heart surgery(Turkiye Klinikleri, 2013) Acipayam, Mehmet; Sunar, Hasan; Canbaz, Suat; Hüseyinova, Gülara; Erbaş, Hakan; Erten, Oya; Duran, EnverObjective: The purpose of the study was to investigate the effects of vitamin E in the protection of the lung from potential ischemia-reperfusion injury during elective coronary artery bypass graft surgery. Material and Methods: This controlled randomized single-center study included patients who underwent elective coronary bypass grafting (CABG) operation. Forty-nine patients were randomly divided into 2 groups. Water soluble Vitamin E (100 mg) in tepid saline (n=25) or tepid saline alone (n=24) was administered via the jugular vein before the aortic cross clamping. Serum total antioxidant capacity (TAC) levels and serum malonedialdehyde levels (MDA) were measured. Pulmonary biopsies were obtained before the aortic cross clamping and 60 minutes after removing the cross clamp. Biopsies were examined histopathologically under electron microscopy. Results: Serum MDA levels at T1 (15 minutes after removal of the cross clamp) and T2 (30 minutes after removal of the cross clamp) were higher in the control group compared to the Vitamin group. Serum TAC levels at T1, T2 and T3 (60 minutes after removal of the cross clamp) were higher in the Vitamin E group compared to the control group. Histopathologic injury grade was lower in the Vitamin E group than in the control group. Conclusion: Vitamin E was found to be protective against reperfusion induced oxidative injury in the early operative period. © 2013 by Türkiye Klinikleri.Öğe The factors affecting the patency of arteriovenous fistulas formed for hemodialysis: evaluation of three-year experience(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2013) Acipayam, Mehmet; Zor, Hakan; Yildiz, Gur Deniz; Uncu, Hasan; Cetinoglu, Mahmut; Halici, Umit; Altinay, LeventBackground: In this study, we assessed surgical techniques used for arteriovenous (AV) fistula formed for hemodialysis and factors affecting the fistula patency in the midterm. Methods: Between April 2007 and July 2010, 530 patients (297 males, 233 females; mean age 57.3 years; range 18 to 86 years) who underwent AV fistula operation were retrospectively analyzed. The patients were divided into two groups including group 1 without AV fistula occlusion (n=411; mean age 57.6 years) and group 2 with AV fistula occlusion (n=119; mean age 56.0 years). Both groups were compared according to following variables: age, sex, diabetes, hypertension, coronary artery disease, cephalic vein and radial artery diameter, postoperative thrill existence on AV fistula and the rate of revision surgery. Results: Distribution of possible risk factors within group 1 and group 2 were as follows respectively: diabetes 82 and 49 patients, hypertension 82 and 29 patients, male sex 243 and 54 patients, coronary artery disease six patients and null, small-diameter radial artery six and four patients, small-diameter cephalic vein 16 and 11 patients, revision surgery eight and five patients, palpable postoperative thrill 377 and 100 patients. We found significant differences in the factors including sex, diabetes, cephalic vein radius and postoperative thrill between the groups (p=0.008, p=0.000, p=0.0019, p=0.0014, respectively). Conclusion: In patients with chronic renal failure, diabetes, female gender and cephalic vein diameter of <2 mm affect the patency of AV fistula adversely, while postoperative trill and male gender affect the patency of AV fistula positively.Öğe Is the risk of isolated coronary artery bypass graft surgery in women aged above 75 years higher compared to men?(Turk Gogus Kalp Damar Cerrahisi Dergisi, 2014) Uncu, Hasan; Acipayam, Mehmet; Altinay, Levent; Gençaslan, Murat; Çakir, Habib; Özsöyler, IbrahimBackground: This study aims to investigate the possible differences of male and female patients aged above 75 years undergoing isolated coronary artery bypass graft surgery (CABG) and to define the risk factors. Methods: Between January 2004 and January 2012, a total of 174 isolated on-pump CABG patients (121 males, 53 females; mean age 77.1 years; range 75 to 97 years) using cardiopulmonary bypass were retrospectively analyzed. The patients were divided into two groups according to their sex: Group 1 consisted of male patients, while group 2 consisted of female patients. Preoperative risk factors, intraoperative and postoperative data and early mortality rates of both groups were compared. Results: The incidence of diabetes mellitus and EuroSCORE values were higher in females, while smoking rates were higher in males (p=0.012; p<0.01; p<0.01, respectively). The number of graft per patient and mediastinal drainage volume were higher in males, whereas the length of intensive care unit stay was longer in females (p=0.039; p=0.041; p<0.01, respectively). The left internal mammary artery graft utilization, need for inotropic support, intra-aortic balloon pump support, neurological complications, the incidence of atrial fibrillation and length of hospital stay were similar in both groups. There was no significant difference in the mortality rates between the groups [group 1, 1.7% (n=2); group 2, 3.8% (n=2)]. Conclusion: Although women aged above 75 years may have a higher incidence of diabetes mellitus, EuroSCORE values and length of intensive care unit stay compared to age-matched men, CABG operations can be done with similar mortality rates.Öğe Our experiences with proximal aortic anastomosis assist device in coronary artery bypass graft surgery(Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2016) Pekedis, Mehmet Alaaddin; Acipayam, Mehmet; Uncu, Hasan; Yildiz, Gur Deniz; Cakallioglu, Ahmet; Dogan, Pinar; Ozsoyler, IbrahimBackground: This study aims to report our experiences with the proximal aortic anastomosis assist device during coronary artery bypass grafting. Methods: Between January 2006 and May 2010, a total of 26 patients (23 males, 3 females; mean age 72.6 +/- 5.8 years; range 55 to 81 years) who underwent bypass surgery using the proximal aortic anastomosis assist device in our clinic were retrospectively analyzed. The indications for the utilization of the device were the presence of proximal aortic calcifications and atherosclerotic plaques in coronary artery bypass graft surgery and insufficient proximal aortic exploration additionally in redo coronary artery bypass graft surgery. Embolic events, neurological complications, the length of intensive care unit stay, and mortality rate were recorded. Results: Off-pump single-vessel or two-vessel coronary artery bypass grafting without cardiopulmonary bypass was performed in 19 patients, while off-pump three-vessel coronary artery bypass grafting under cardiopulmonary bypass was performed in seven patients. Six patients underwent redo coronary artery bypass grafting. No neurological complications, embolic events or mortality were observed in any patients. Conclusion: Proximal aortic anastomosis assist devices considerably facilitate proximal anastomosis in indicated patients undergoing coronary artery bypass grafting. We believe that the utilization of these devices may also reduce the proximal anastomosis site-related complications which may occur during coronary artery bypass grafting.Öğe Pseudoaneurysm of the Carotid Arterial System(Lippincott Williams & Wilkins, 2014) Bayarogullari, Hanifi; Acipayam, Mehmet; Akbay, Ercan; Atci, Nesrin; Davran, Ramazan; Cevik, CengizPseudoaneurysms of internal, external, and common carotid arteries are seen rarely. Blunt traumas caused by automobile accidents are the prior reasons to this. Central venous catheterization, ballistic trauma, cystic medial necrosis, fibromuscular dysplasia, atherosclerosis, and other inflammatory processes are some other potential reasons for pseudoaneurysm. In contrast to true aneurysms, it does not contain 3-layer structure with adventitia, media, and intima sublayers in its wall. The wall contains coagulum and fibrous capsules. Clinically, after trauma, it presents itself as swelling after days to weeks of damage to vascular walls. Because it causes morbidity and mortality when it is ruptured, It should be treated via surgical or vascular intervention.Öğe A RETROSPECTIVE COMPARISON OF EARLY RESULTS OF ISOLATED CORONARY ARTERY BYPASS SURGERY IN YOUNG (<40 YEARS) AND MIDDLE AGED (40-60 YEARS) PATIENTS(Carbone Editore, 2015) Halici, Umit; Acipayam, Mehmet; Uncu, Hasan; Altinay, Levent; Ketenciler, Serkan; Ozsoyler, IbrahimIntroduction: Coronary artery disease is usually seen in middle-aged and older population. Although coronary artery disease in young patients is relatively rare compare to older population, the incidence in young people have been increasing recently. In this retrospective study, we aimed to compare the perioperative characteristics and complications of young aged (<40 years) to midlle aged (40-60 years) patients retrospectively. Materials and methods: A total of 1592 patients who underwent isolated coronary artery bypass grafting operation were included in this retrospective study. Patients were divided into two groups according to age as young aged patients (Group 1; a total of 78 patients; 64 males, 14 females, mean age 36.7 +/- 33 years) and middle-aged patients (Group 2; a total of 1514 patients; 1183 males and 331 females, mean age 51.8+/-5.2 years) and preoperative, intraoperative and postoperative parameters were compared. Results: Smoking rates in Group 1 and low molecular density cholesterol levels in Group 2 were higher but it was not statistically significant. Cardiopulmonary bypass time, cross-clamp time, incidence of reoperation, amount of drainage and number of distal anastomoses were not significantly different between groups. Also development of newly onset atrial fibrillation, use of inotropic agents, intensive care stay time, amount of fresh whole blood used, use of left internal thoracic artery and intraaortic balloon pump seen in groups were not statistically significant. The incidence of delirium and time to discharge were significantly increased in Group 2. Hospital mortality rate of Group 2 was 0.39% (6 patients) whereas there was no hospital mortality in Group 1. Conclusion: The coronary bypass grafting operation can be performed in young aged patients with similar early postoperative results as in middle aged patients group. Thus we think that age has no major effect over the early postoperative results of isolated coronary artery bypass surgery.Öğe A retrospective comparison of early results of isolated coronary artery bypass surgery in young (<40 years) and middle aged (40-60 years) patients(Acta Medica Mediterranea, 2015) Halici, Umit; Acipayam, Mehmet; Uncu, Hasan; Altinay, Levent; Ketenciler, Serkan; Ozsoyler, IbrahimIntroduction: Coronary artery disease is usually seen in middle-aged and older population. Although coronary artery disease in young patients is relatively rare compare to older population, the incidence in young people have been increasing recently. In this retrospective study, we aimed to compare the perioperative characteristics and complications of young aged (<40 years) to midlle aged (40-60 years) patients retrospectively. Materials and methods: A total of 1592 patients who underwent isolated coronary artery bypass grafting operation were included in this retrospective study. Patients were divided into two groups according to age as young aged patients (Group 1; a total of 78 patients; 64 males, 14 females, mean age 36.7±3.3 years) and middle-aged patients (Group 2; a total of 1514 patients; 1183 males and 331 females, mean age 51.8±5.2 years) and preoperative, intraoperative and postoperative parameters were compared. Results: Smoking rates in Group 1 and low molecular density cholesterol levels in Group 2 were higher but it was not statistically significant. Cardiopulmonary bypass time, cross-clamp time, incidence of reoperation, amount of drainage and number of distal anastomoses were not significantly different between groups. Also development of newly onset atrial fibrillation, use of inotropic agents, intensive care stay time, amount of fresh whole blood used, use of left internal thoracic artery and intraaortic balloon pump seen in groups were not statistically significant. The incidence of delirium and time to discharge were significantly increased in Group 2. Hospital mortality rate of Group 2 was 0.39% (6 patients) whereas there was no hospital mortality in Group 1. Conclusion: The coronary bypass grafting operation can be performed in young aged patients with similar early postoperative results as in middle aged patients group. Thus we think that age has no major effect over the early postoperative results of isolated coronary artery bypass surgery.Öğe Single-stage repair of the anterior chest wall following sternal destruction complicated by mediastinitis(Springer, 2014) Zor, Mustafa Hakan; Acipayam, Mehmet; Bayram, Huseyin; Oktar, Levent; Erdogan, Mustafa; Darcin, Osman TanselAlthough various techniques have been described, the ideal reconstructive procedure for treating massive sternal fragmentation and necrosis is still a matter of debate. Sometimes, reconstruction is so challenging that repetitive operations are required, particularly when complicated by mediastinitis and sternal osteomyelitis. Five patients (three males, two females, median age 66) with severe osteomyelitis and sternal destruction after receiving myocardial revascularization underwent partial or radical sternal resection, omental flap transposition, titanium mesh implantation and rectus abdominis muscle flap transposition. The final procedure involved single-stage closure. One patient died 9 days after the final procedure due to pneumonia and septicemia. The other patients received antibiotics for at least 6 weeks postoperatively. The mean hospital stay was 36 days. Optimal wound healing was observed, with acceptable cosmetic disorders. Although lateral sternal support is the first-line surgical treatment for sternal dehiscence, performing primary closure of complicated defects is often impossible. Aggressive treatment modalities are required in such cases for anterior chest wall defects. This technique provides the ability to perform rigid and stable sternal closure in complicated cases.
