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Öğe The arteriovenous fistulas for hemodialysis complications in short and long term in department of cardiovascular surgery clinic turgut ozal medical center(Journal of Turgut Ozal Medical Center, 2011) Çolak, Mehmet Cengiz; Dişli, Olcay Murat; Erdil, Nevzat; Cihan, H. Berat; Battaloğlu, BektaşÖğe Atrial fibrillation after coronary artery bypass grafting in elderly patients ıncidence and risk factor analysis(The Thoracic and Cardiovascular Surgeon, 2007) Nisanoğlu, Vedat; Erdil, Nevzat; Aldemir, Mustafa; Özgür, Bülent; Cihan, H. Berat; Yoloğlu, Saim; Battaloğlu, BektaşObjective: New-onset atrial fibrillation (AF) is the most frequent arrhythmic complication after coronary artery bypass grafting (CABG). Elderly patients who undergo this operation may have a different risk profile from the general population. The aim of this study was to identify risk factors for post-CABG AF in the elderly population. Methods: Between September 2001 and December 2005, 426 elderly patients (age ≥ 65 years) underwent CABG at our center. Ninety-one developed post-CABG AF (AF group), and the other 335 (no-AF group) did not develop this complication. Multivariate analysis (odds ratio, ± 95 % CI, p value) was used to identify independent clinical predictors of post-CABG AF. Results: The incidence of post-CABG AF in elderly patients during the study period was 21.4 %. Multivariate analysis identified age (OR 1.07, p < 0.009), age ≥ 75 years (OR 1.77, p < 0.042), preoperative renal insufficiency (OR 5.09, p < 0.035), EuroSCORE (OR 1.18, p < 0.038), and cross-clamping time (OR 1.02, p < 0.012) as predictors of AF occurrence. The AF group had a significantly longer mean intensive care unit (ICU) stay (3.8 ± 4.7 vs. 2.5 ± 1.3 days for AF vs. no-AF; p = 0.0001), and a significantly higher proportion of patients with prolonged (≥ 6 days) ICU stays (8.8 % vs. 3.2 %, respectively; p = 0.033). Hospital mortality was 3.2 % in the no-AF group and 2.2 % in the AF group (p = 0.74). Conclusion: This study of elderly patients reveals some novel predictors of post-CABG AF, most notably preoperative renal insufficiency and EuroSCORE. It is important to identify risk factors for post-CABG AF in all patient groups as this knowledge might lead to better prevention of this problem and its potential consequences.Öğe Complete myocardial revascularization using arterial grafts only in patients with unstable angina ımpact on early outcome(The Thoracic and Cardiovascular Surgeon, 2007) Nisanoğlu, Vedat; Battaloğlu, Bektaş; Erdil, Nevzat; Özgür, Bülent; Cihan, H. BeratObjective: The aims of this study were 1) to assess early clinical outcomes for patients with unstable angina (UA) who undergo urgent/emergent coronary artery bypass grafting (CABG); and 2) to evaluate the feasibility and safety of complete revascularization using strictly arterial grafts in this patient group. Patients and Methods: Between September 2001 and May 2005, a total of 961 patients underwent CABG at our center. One hundred and sixty-seven (17.4 %) of these individuals underwent urgent or emergent CABG because of UA, and 794 (82.6 %) underwent elective CABG for stable angina (SA). Of the 167 patients with UA, 59 (35.3 %) underwent complete revascularization using arterial grafts only (AO subgroup: internal thoracic arteries and radial arteries) and the other 108 received a combination of arterial and venous grafts (AV subgroup: 1 internal thoracic artery plus saphenous vein grafts). Results: The UA group had a significantly higher proportion of women and a significantly higher rate of left main coronary artery disease than the SA group (p = 0.016 and p = 0.0001, respectively). Cardiopulmonary bypass time was significantly longer in the UA group (p = 0.01). Higher proportions of the UA group required inotropic support (p = 0.001), intra-aortic balloon pump support (p = 0.001), and re-exploration for bleeding or cardiac tamponade (p = 0.005). This group also had a significantly longer mean time on mechanical ventilation (p = 0.001) and a longer mean intensive care unit stay (p = 0.01). The rates of operative mortality (first 30 days) in the SA and UA groups were 1.8 % and 6 %, respectively (p = 0.001). There were no statistical differences between the AO and AV subgroups with respect to any of the preoperative or intraoperative findings. The AO group had a significantly shorter mean intensive care unit stay than the AV group (p = 0.05). The AV group had a roughly fivefold higher operative mortality than the AO group (8.3 % vs. 1.7 %, respectively), but this difference was not statistically significant (p = 0.17). Conclusion: Urgent or emergent CABG in the setting of UA is associated with increased but acceptable rates of mortality and morbidity. Complete myocardial revascularization using arterial grafts only (combinations of internal thoracic and radial arteries) is feasible and safe in this patient group.Öğe Early outcomes of radial artery use in all arterial grafting of thecoronary arteries in patients 65 years and older(Texas Heart Instıtute Journal, 2010) Erdil, Nevzat; Nisanoğlu, Vedat; Eroğlu, Tamer; Fansa, Iyad; Cihan, H. Berat; Battaloğlu, BektaşWe retrospectively evaluated early clinical results of coronary revascularization using none but arterial grafts in patients aged 65 years and older. The cases of 449 consecutive patients who had undergone isolated myocardial revascularization were divided into 2 groups: the arterial conduit group (n=107) received a left internal mammary artery (LIMA) graft and 1 or both radial arteries (RAs), while the mixed-conduit group (n=342) received a LIMA graft and 1 or more saphenous vein grafts (SVGs), with or without an RA. There was no significant difference between the groups’ rates of mortality. The arterial conduit group had a significantly shorter overall postoperative hospital stay than did the mixed-conduit group (mean, 6.6 ± 0.9 vs 7.2 ± 5 days; P=0.04). Linear regression analysis revealed that the presence of hypertension (β=0.13; 95% confidence interval [CI], 0.054–0.759; P=0.02) and high EuroSCORE (β=0.24; 95% CI, 0.053–0.283; P=0.004) were the major predicting factors for long hospital stay. Graft-harvest-site infection was statistically more frequent in the mixed-conduit group than in the arterial conduit group (6.4% vs 0, respectively; P=0.007). Angiography was performed postoperatively (mean, 24.9 ± 16.3 mo; range, 11–65 mo) in 21 patients. In these patients, all LIMA grafts were patent, as were 86.9% of the SVGs and 90.9% of the RA grafts. Myocardial revascularization using all arterial grafts (at least 50% RAs) in patients aged 65 years and older is safe and reliable, produces short-term results equal to those of saphenous vein grafting, and can reduce graft-harvest-site infections. (Tex Heart Inst J 2010; 37(3):301-6)Öğe Effect of posterior pericardiotomy on early and late pericardial effusion after valve replacement(Journal of Cardiac Surgery, 2005) Nisanoğlu, Vedat; Erdil, Nevzat; Battaloğlu, Bektaş; Koşar, Feridun; Erdil, Feray Akgül; Cihan, H. BeratPericardial effusion (PE) after cardiac surgery is frequent. It is more frequently seenafter valve replacement or other types of heart surgery. Oral anticoagulants and antiplatelet agents mayinduce effusion development after open heart surgery. Our objective was to determine the efficiency ofposterior pericardiotomy (PP) after cardiac valve operation for reducing the incidence of early and late PEand tamponade.Methods: This prospective randomized study was carried out in 100 consecutive patientsundergoing mechanical valve replacement between August 2001 and May 2003 in our institution. Patientswere divided into two groups; each group consisted of 50 patients. Longitudinal incision was made paralleland posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm inGroup 1. Posterior pericardiotomy was not done in Group 2.Results: Early PE was detected in four patients(8%) and in 19 patients (38%) in Group 1 and Group 2, respectively (p < 0.001). No late PE effusion wasdeveloped in Group 1 despite nine (18%) late PE developing in Group 2 (p < 0.003). The rate of delayedpericardial tamponade was lower in Group 1, but this difference was not statistically significant (0% vs 10%;p < 0.056).Conclusion: These findings suggest that PP is an easy, feasible, and beneficial technique forreducing both the occurrence of early and late PE or pericardial tamponade in patients undergoing valvereplacement.Öğe Koroner arter cerrahisinde tek kros klemp tekniğinin erken dönem sonuçlara etkisi(Turkiye Klinikleri Cardiovascular Sciences, 2006) Nisanoğlu, Vedat; Erdil, Nevzat; Özgür, Bülent; Erdil, Feray Akgül; But, A. Kadir; Çolak, Mehmet Cengiz; Cihan, H. Berat; Battaloğlu, BektaşAmaç: Koroner arter bypass cerrahisinde distal ve proksimal anastomozlar tek aortik klemp ile yapmak, nörolojik ve kardiyak hasarı azaltabilir. Bu çalışmada, tek ve çift klemp tekniklerinin erken postoperatif sonuçlar üzerine etkilerini inceledik. Gereç ve Yöntemler: Yaklaşık 3 yıllık bir dönemde, 774 izole koroner arter cerrahisi işlemi gerçekleştirildi. Grup 1'de, aortik tek klemp kullanılarak cerrahi revaskülarizasyon yapılan 391 hasta bulunurken, Grup 2'de çift aortik klemp tekniği kullanılan 383 hasta vardı. Bu iki grup postoperatif erken dönem sonuçlar bakımından karşılaştırıldı. Bulgular: Aortik kros klemp süresi, tek klemp tekniği uygulanan grupta istatistiksel olarak anlamlı bir şekilde uzun idi (p= 0.0001). Kardiyopulmoner bypass süreleri bakımından gruplar arasında anlamlı farklılık yoktu (p= 0.546). Erken mortalite oranı her iki grupta benzer idi (Grup 1 %2.1; Grup 2 %1.8, p= 0.642). Postoperatif nörolojik ve kardiyak olay açısından iki grup arasında istatistiksel fark tespit edilmedi. Sonuç: Postoperatif komplikasyonlar açısından, tek ve çift klemp teknikleri karşılaştırıldığında istatistiksel olarak anlamlı farklılık bulunmadığı sonucuna vardık.
