Browsing by Author "Ercan, Abdülkadir"
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Item A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE(BMC, 2014) Ercan, Abdülkadir; Kara, İlker Hasan; Gürbüz, Orçun; Kumtepe, Gencehan; Önder, Tolga; Saba, Davit; Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.; 55987378200Background: The aim of the present study was to evaluate and compare postoperative short-term, mid-term and long-term outcomes of coronary artery bypass surgery performed with or without cardiopulmonary bypass in patients with a low European System for Cardiac Operative Risk Evaluation score. Methods: A retrospective analysis of 478 consecutive low risk patients undergoing coronary bypass surgery between January 2002 and December 2007 was performed. Of these patients, 83 cases had undergone on-pump and 395 cases had undergone off-pump coronary bypass surgery. The patients were assessed in terms peri-operative complications, survival, mortality due to cardiac events, need for rehospitalization and repeated coronary revascularization. Results: There was no significant difference between the two groups in terms of preoperative characteristics, except for chronic obstructive pulmonary disease. The number of distal anastomosis per patient was significantly lower in the off-pump group than in the on-pump group (2.66 +/- 0.74 vs. 3.21 +/- 0.85, p < 0.001). Early mortality rates were similar in both groups (1.01% for the off-pump group and 1.2% for the on-pump group, p = 0.687). Neurological complications were significantly lower in the off-pump group than in the on-pump group (1.1% vs. 6%, p = 0.01). The mean follow-up period was 80 +/- 19.1 months (range, 3-112 months). The need for revascularization during long-term follow-up was 10.1% in the off-pump group and 7.2% in the on-pump group (p = 0.416). The 5-year survival was 95.2 +/- 1.1% and 95.5 +/- 2.7% in the off-pump and on-pump groups, respectively (p = 0.8), whereas the 7-year survival was 91.9 +/- 1.6% and 84.7 +/- 6.8% in the off-pump and on-pump groups, respectively (p = 0.274). The 5-year revascularization-free period was 89.5 +/- 1.6% and 89.7 +/- 3.5% in the off-pump and on-pump groups, respectively (p = 0.785). The 7-year revascularization-free period was 71.1 +/- 3.1% and 73.5 +/- 7.3% in the off-pump and on-pump groups, respectively (p = 0.075). The 7-year event-free survival was 80.1 +/- 2.2% and 73.4 +/- 7.3% in the off-pump and on-pump groups, respectively (p = 0.377). Conclusions: The present study demonstrated that off-pump cardiac surgery had advantages over on-pump cardiac surgery in the short term; however, both interventions had similar mid-term and long-term outcomes, when performed in low-risk patient.Item Hemodinamisi stabil transmediastinal ateşli silah yaralanmalarında tedavi yaklaşımı(Ulusal Travma ve Acil Cerrahi Derneği, 2009-03) Bayram, Ahmet Sami; Biçer, Murat; Ercan, Abdülkadir; Gebitekin, Cengiz; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Kalp Damar Cerrahisi Anabilim Dalı.; ABB-7580-2020; AAE-1069-2022; ABC-2231-2020; 8347194000; 6507770944; 55398003800; 6602156436Transmediastinal ateşli silah yaralanmaları hasta hayatını tehdit eden kalp, büyük damar, özofagus ve/veya akciğer gibi organların yaralanması ile sonlanabilir. Hemodinamik açıdan stabil olan hastalarda, tanıya yönelik incelemeler ve seçilecek tedavi yöntemleri tartışmalı noktalar içermektedir. Bu yazıda, hemodinamik açıdan stabil, transmediastinal ateşli silah yaralanması bulunan ve tanısal testler sonucunda üçü ameliyata alınan beş olgudaki deneyimlerimizi sunduk. Ameliyata karar vermeden önce hemodinamik açıdan stabil transmediastinal ateşli silah yaralanması olan olgularda tanısal testler sistematik olarak yapılmalıdır.Item Is 100% beating heart coronary by-pass justified?(Elsevier Science, 2002-12) Davit, S.; Şenkaya, Işık; Kan, İrem İris; Özkan, Hayati; Ercan, Abdülkadir; Uludağ Üniversitesi/Tıp Fakültesi/Kardiyoloji Anabilim Dalı.; 55987378200; 6603498369; 55398003800; 7004267827; 7103355993Coronary by-pass on a beating heart may provide a safer form of surgical revascularization by avoiding the well-documented side effects of cardiopulmonary by-pass. In addition, off-pump bypass is suggested to be a good alternative to on-pump especially in high risk patients. This study reviews the feasibility of coronary by-pass on the beating heart in all patients referred to surgery. Two hundred and ninety-four patients operated on the beating heart were prospectively followed and compared to the control group of 100 consecutive patients operated with the conventional method. There were no significant differences between the groups with respect to risk factors, except the incidence of chronic obstructive pulmonary disease and ejection fraction which were higher in the conventional group, whereas peripheral vascular disease was higher in the beating heart group. There was more distal anastomosis in the conventional group. Postoperative inotrope requirement, peak creatine phosphokinase-MB, ventilation time, blood loss in the first 24 h, transfusion needs, new atrial fibrillation and length of hospital stay were significantly lower in the beating heart operations. However, there were no significant differences between the groups in terms of neurological complications, chest infection, intraaortic balloon pump usage and mortality. In conclusion, multivessel off pump coronary by-pass is feasible with the same or better results as it is observed in the conventional technique when postoperative bleeding, neurogenic complications, arrythmias, hospital stay, overall morbidity and mortality are compared.Item Kardiyopulmoner baypasın kalp kası üzerine etkileri(Uludağ Üniversitesi, 2017-09-26) Kumtepe, Gencehan; Gürbüz, Orçun; Karal, İlker Hasan; Yüksel, Ahmet; Ercan, Abdülkadir; Saba, DavitBu çalışma, kalp-akciğer makinası kullanılarak ve kullanılmadan atan kalpte koroner baypası yapılan olgularda, kalp-akciğer makinasının kalp kası üzerine etkilerini değerlendirmek için tasarlandı. Kliniğimize isteğe bağlı koroner baypas yapılmak üzere refere edilmiş 20 olgu, eşit iki gruba ayrılarak prospektif ve randomize olarak çalışmaya alındı. Birinci gruba atan kalpte coroner baypası ve ikinci gruba kalpakciğer makinası kullanılarak atan kalpte coroner baypası operasyonu uygulandı. Olgulardan preoperatif creatinine kinase-myocardial bound (CK-MB), cardiac troponin I (cTnI), N-terminal pro-brain natriüretik peptide (NT-pro-BNP) ve karbonhidrat reaktif protein (CRP) düzeylerine, postoperatif 4, 12, 24, 48. saatlerde CK-MB ile cTnI, 4, 24. saatlerde NT-pro-BNP ve 24. saatte CRP düzeylerine bakılmak üzere venöz kan örnekleri alındı. Grup 1’de hasta damar sayısının daha düşük olmasıyla ilişkili olarak, distal anastomoz sayısı (2.1±0.3) anlamlı olarak Grup 2’den (3.3±0.9) daha düşüktü (p=0.004). Miyokardiyal hasar göstergeleri olarak değerlendirdiğimiz CK-MB ve cTnI düzeylerini karşılaştırdığımızda, gruplar arasında postoperatif CK-MB düzeyleri açısından fark yoktu. Grup 2’de cTnI düzeyleri postoperatif 12, 24 ve 48. saatlerde daha yüksek olarak saptandı. Postoperatif kardiyak fonksiyonları değerlendirmek için baktığımız NT-pro-BNP düzeyleri, Grup 2’de 4. saatte anlamlı olarak daha yüksekti. İnflamasyon göstergesi olarak değerlendirdiğimiz CRP düzeyleri açısından gruplar arasında anlamlı fark saptanmadı.Item Vascular complications of intra-aortic balloon pump usage in coronary bypass surgery: 18 years of experience(Pakistan Medical Assoc, 2014-01) Ercan, Abdülkadir; Gürbüz, Orçun; Ercan, Arzu; Özkan, Hayati; Tüydeş, Oktay; Biçer, Murat; Saba, Davit; Uludağ Üniversitesi/Tıp Fakültesi/Kalp Damar Cerrahisi Anabilim Dalı.; ABC-2231-2020; 36115722000; 6507770944; 55987378200Objective: To evaluate the vascular complication incidence related to intra-aortic balloon pump usage during coronary bypass surgery and possible risk factors. Methods: The retrospective study was conducted at Uludog University Hospital, Turkey, and comprised 147 cases in which intra-aortic balloon pump was used during coronary artery bypass surgery between January 1994 and December 2011. Data was examined in terms of age, gender, diabetes mellitus, hypertension, smoking, peripheral vascular disease, pre-operative serum creatinine, history of congestive heart failure, left ventricular ejection fraction, previous infarction and cardiac functional capacity. Time, indication, treatment duration, technique of insertion and complications were recorded about the balloon insertion. Patients in whom peripheral vascular complication developed were evaluated with pulse examination, Doppler ultrasound and angiography. Logistic regression analyses were carried out with the purpose of determining the relation between pre-operative clinical variables and vascular complications and mortality. Results: Of the total, 105 (71%) were males and 42 (28%) were females. The overall mean age was 62.4 +/- 10.1 years. Besides, 16(41%) cases had diabetes mellitus and 30(20%) had peripheral artery disease. The mean Euroscore was 7.6 +/- 4.8. Intra-aortic balloon pump was inserted in 16 (10.8%) due to pre-operative high risk and in 75 (51%) cases due to hypotension being non-responsive to inotropes. Balloon catheter was placed with percutaneous technique in 141 (96%) cases and sheath wasn't used in 44 (29%). The balloon stayed for 2.9 +/- 2.1 days on average. Balloon rupture developed in 1 (0.6%) case. Mortality resulted in 58 (39%) cases. Euroscore (p=0.012), staying in hospital (p=0.005), low ejection fraction (p=0.018), hypertension existence (p=0.003) in multivariate logistic regression analyses were found significant in terms of affecting mortality. Duration of therapy (p<0.001), existence of sheath (p=0.002), and existence of peripheral vascular disease (p<0.001) were found significant as factors affecting the development of vascular complication. Conclusion: Intra-aortic balloon pump provides mechanical circulation assistance during coronary artery surgery, but peripheral vascular system should be well evaluated in order to avoid vascular complications and the balloon catheter should be placed without the sheath if necessary. The duration of the therapy is a risk factor for the development of vascular complication.