Browsing by Author "Kumtepe, Gencehan"
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Item Are really the early postoperative outcomes of coronary artery bypass grafting surgery in elderly women worse compared to men?(Elsevier, 2017-04-15) Yüksel, Ahmet; Velioğlu, Yusuf; Cayır, Mustafa Çağdaş; Kumtepe, Gencehan; Kan, İrem İris; Yolgösteren, Atıf; Biçer, Murat; Tok, Mustafa; Şenkaya, Işık; Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.; AAG-2372-2021; ABC-2231-2020Item Are the early postoperative outcomes of coronary artery bypass grafting surgery in elderly women worse compared to men’s?(Social Brasileira Cirurgia Cardiovascular, 2017-06) Yüksel, Ahmet; Velioğlu, Yusuf; Çayır, Mustafa Çağdaş; Gürbüz, Orçun; Kumtepe, Gencehan; Kan, İrem İris; Yolgösteren, Atıf; Akarsu, Serkan; Biçer, Murat; Tok, Mustafa; Şenkaya, Işık; Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.; AAG-2372-2021; ABC-2231-2020; 7004267827; 57193236800; 57190135053; 6507770944; 6506976035; 6603498369Abstract Objective: To investigate the impact of gender difference in early postoperative outcomes in elderly patients (aged 70 or older) undergoing coronary artery bypass grafting surgery. Methods: Between October 2009 and December 2013, a total of 223 elderly patients (aged 70 or older) undergoing isolated primary coronary artery bypass grafting surgery were included in this retrospective observational cohort study. Patients were divided into two groups according to their gender. The patients' medical records were collected, their baseline preoperative characteristics, operative data, and postoperative outcomes were retrospectively reviewed, and the effect of gender difference in the early postoperative outcomes was analyzed. Results: Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152 patients, respectively. Mean age of patients was 74.4±3.6 years (range: 70-84 years). The level of EuroSCORE I, the incidence of hypertension and hyperlipidemia were significantly higher in Group 1, while the rate of smoking was significantly higher in Group 2. Mean postoperative intubation time, length of intensive care unit and hospital stay were longer in female patients than in male patients, but these differences were not statistically significant. No statistically significant difference between two groups in terms of the transfusion of blood products was observed. The rates of in-hospital mortality and major postoperative complications were statistically similar between the two groups. Conclusion: In conclusion, the female gender was not associated with worse early postoperative outcomes in elderly patients undergoing coronary artery bypass grafting surgery.Item A comparison of off-and on-pump beating-heart coronary artery bypass surgery on long-term cardiovascular events(Clinics Cardive Publication, 2017) Gürbüz, Orçun; Kumtepe, Gencehan; Özkan, Hakan; Karal, İlker Hasan; Ercan, Abdulkadir; Ener, Serdar; Yolgösteren, Atıf; Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.; AAG-2372-2021; 57193236800Objective: Our aim was to compare short-term outcomes and long-term major adverse cardiovascular event (MACE)-free survival and independent predictors of long-term MACE after off-pump (OPCAB) versus on-pump beating-heart (ONBHCAB) coronary artery bypass grafting (CABG). Methods: We retrospectively reviewed data of all consecutive patients who underwent elective CABG, performed by the same surgeon, from January 2003 to October 2009. A propensity score analysis was carried out to adjust for baseline characteristics and a total of 398 patients were included: ONBHCAB (n = 181), OPCAB (n = 217). Results: OPCAB was associated with significantly shorter ventilation times (p < 0.001), intensive care unit stay (p < 0.001) and hospital stay (p < 0.001). The total blood loss was significantly more in the ONBHCAB group (p < 0.001), and accordingly, the number of transfused blood units was significantly lower in the OPCAB group (p < 0.001). Incidence of peri-operative renal complications were significantly higher in the ONBHCAB group (p = 0.004). The OPCAB group showed significantly lower long-term MACE-free survival (p = 0.029). The mean number of transfused blood units was the only independent predictor of MACE (HR: 1.218, 95% CI: 1.089-1.361; p = 0.001). Conclusion: OPCAB provided better long-term MACE-free survival compared with ONBHCAB. Fewer units of blood transfused following OPCAB surgery may have been the main reason for this result.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.Publication Evaluation of polylactide film for prevention of pericardial adhesion in a rabbit model(Baycinar Medical Publ-Bayçınar Tıbbi Yayıncılık, 2015-01-01) Gürbüz, Orçun; Ercan, Abdulkadir; Biçer, Murat; Kumtepe, Gencehan; Bayram, Sami; Şenkaya, Işık; Saba, Davit; BİÇER, MURAT; BAYRAM, AHMET SAMİ; ŞENKAYA SIĞNAK, IŞIK; Saba, Davit; Uludağ Üniversitesi/Tıp Fakültesi/Kalp Damar Cerrahisi Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Cerrahisi Anabilim Dalı.; ABC-2231-2020; ABB-7580-2020; DTC-2331-2022; DPS-9311-2022Background: This study aims to evaluate the efficacy of a bioabsorbable polylactide film, which was proven to be effective in preventing pelvic adhesions, in prevention of postoperative pericardial adhesions in an animal model.Methods: Forty New Zealand white rabbits were divided equally into control and treatment groups. Subjects were performed left anterior thoracotomy and partial pericardiectomy followed by epicardial abrasion. In control groups (group 1 and 2), the pericardium was left open to allow retrosternal adhesions. In treatment groups (group 3 and 4), the pericardial defect was closed with 0.02 mm bioabsorbable polylactide film. Postoperative macroscopic and microscopic evaluations were made by the same blinded observers at the end of the third week in group 1 and 3, and at the end of the sixth week in group 2 and 4.Results: Macroscopic and histopathologic examinations revealed no significant differences between control and treatment groups in terms of adhesion formation. However, polylactide film supported the growth of a mesothelium-like layer in the treatment groups.Conclusion: Although polylactide film assists in the regeneration of mesothelial cells layer, it does not prevent the development of pericardial adhesions.Item In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection - Does cyanoacrylate increase the severity of infection?(Hogrefe AG-Hogrefe AG Suisse, 2020-06) Kumtepe, Gencehan; Yolgösteren, Atıf; Payaslıoğlu, Ayşe Melda; Özakın, Cüneyt; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Anabilim Dalı.; 0000-0001-5428-3630; 0000-0001-5050-5478; AAG-2372-2021; AAG-8392-2021; 57193236800; 57211210890; 57200678942Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.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 Pompalı ya da pompasız çalışan kalpte koroner baypas cerrahisi (KABG) kalp kasını etkiler mi?(Uludağ Üniversitesi, 2009) Kumtepe, Gencehan; Saba, Davit; Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.Bu çalışma, pompa destekli ve desteksiz çalışan kalpte koroner baypas (ÇKKB) yapılan olgularda, pompanın kalp kası üzerine etkilerini değerlendirmek için tasarlandı.Kliniğimize elektif koroner baypas yapılmak üzere refere edilmiş 20 olgu, eşit iki gruba ayrılarak prospektif ve randomize olarak çalışmaya alındı. Birinci gruba ÇKKB ve ikinci gruba pompa destekli ÇKKB operasyonu uygulandı. Olgulardan preoperatif creatinine kinase-myocardial bound (CK-MB), cardiac troponin I (cTnI), brain natriüretik peptid (BNP) ve karbonhidrat reaktif protein (CRP) düzeylerine, postoperatif 4, 12, 24, 48. saatlerde CK-MB ile cTnI, 4, 24. saatlerde 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. Grup 2'deki cTnI yüksekliği, distal anastomoz sayısının fazlalığına bağlı olarak daha fazla iskemi-reperfüzyon süresi ile ilişkili olabilir. Postoperatif kardiyak fonksiyonları değerlendirmek için baktığımız pro-BNP düzeyleri, Grup 2'de 4. saatte anlamlı olarak daha yüksekti. Bu da yine distal anastomoz sayısının fazlalığına bağlı olarak, artmış cerrahi manipülasyon ve ventiküler gerilim süreleri ile ilişkili olabilir. İnflamasyon göstergesi olarak değerlendirdiğimiz CRP düzeyleri açısından gruplar arasında anlamlı fark saptanmadı.Postoperatif miyokardiyal hasar göstergeleri pompa destekli grupta daha yüksek bulundu. Ancak, grupların distal anastomoz sayılarınınhomojenizasyonu sağlanamadığı için, pompa destekli grupta miyokardiyal hasarın daha fazla olduğunu söyleyemeyiz.Item Postoperative outcomes after off-pump coronary artery bypass grafting in EuroSCORE low- and high-risk women(Forum Multimedia Publishing, 2007-12) Yılmaz, Mert; Saba, Davit; Karal, İlker Hasan; Ercan, İlker; Kumtepe, Gencehan; Gürbüz, Orçun; Şenkaya, Işık; Cengiz, Mete; Uludağ Üniversitesi/Tıp Fakültesi/Kalp ve Damar Cerrahisi Anabilim Dalı.; 0000-0001-8553-7939; 0000-0003-3873-992X; 0000-0002-2382-290X; HKO-3722-2023; GWM-7771-2022; 57220839864; 55987378200; 23481592700; 6603789069; 23482178400; 35819579300; 56495079800; 7003766367Background. Many previous studies have reported that women who undergo coronary artery bypass grafting have higher perioperative morbidity and mortality rates than men. The use of off-pump coronary artery bypass grafting (OPCAB) has been suggested to decrease morbidity and mortality because the deleterious effects of cardiopulmonary bypass, particularly in high-risk patients, are avoided. The reduction in unwanted postoperative complications in women undergoing OPCAB surgery has not been extensively investigated. The aim of this retrospective study was to compare perioperative rates of morbidity and mortality and follow-up events after OPCAB in female patients assessed as high- or low-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Methods. The study included 377 adult female patients who underwent elective primary isolated OPCAB. The study patients were divided into 2 groups based on the Additive EuroSCORE: low-risk patients (group I, n=301, EuroSCORE < 6) and high- risk patients (group II, n=76, EuroSCORE >= 6). Results. Patient ages were 60.1 +/- 7.77 years in group I and 69.3 +/- 5.51 years in group II (P <.001). Compared to group I patients, group II patients had significantly higher Additive EuroSCORE (P <.001), predicted mortality rate (Logistic EuroSCORE) (P <.001), and Canada angina classification (P <.001) and higher rates of preoperative myocardial infarction (P <.001), peripheral vascular disease (P <.001), carotid artery disease (P <.005), and hypertension (P <.05). Occurrence of postoperative arrhythmia and mortality were significantly higher (P <.05) in group II. The observed mortality rate in group I was 1%, which was 41% of the predicted mortality rate (Logistic EuroSCORE) of 2.42 +/- 0.76. The observed mortality rate in group II was 5.3%, which was 79% of the predicted rate (6.74 +/- 2.89), but the difference was not significant (P=.2). Intensive care unit length of stay (P <.01) and ventilation times (P <.05) were longer for group II than group I, and the incidence of conversion to cardiopulmonary bypass was 1.6% versus 5.3%, respectively, in groups I and II (P=.08). Conclusion. These results indicate that OPCAB surgery is safe and seems to be an effective surgical technique for lowering rates of morbidity and mortality in high- and low-risk female patients.