Ahmet Coşkun Özdemir

Vascular complications of the intra-aortic balloon pump in patients undergoing open heart surgery: 10 years' experience.

BACKGROUND The most encountered complications with intra-aortic balloon pump (IABP) use are seen within the vascular system. The purpose of our study is to evaluate vascular complications of the sheathless IABP in patients undergoing open heart surgery. METHODS Between January 2002 and December 2011, a total of 148 patients undergoing open heart surgery and needed IABP support were included in the study. All vascular complications related with IABP were recorded. RESULTS Mean age of the patients was 64.4 ± 9.4 years. Total 104 (70.2%) were male and 44 (29.8%) were female. Total number of patients who had ischemic complications of the extremity was 13 (8.7%). The most used surgical treatment was embolectomy in five patients. Only one patient required an iliofemoral bypass. Above the knee amputation was performed in one patient. No balloon-related mortality occurred. CONCLUSION Incidence of vascular complications in IABP counterpulsation is still a problem despite improvements in catheter design and techniques. The presence of peripheral arterial disease and diabetes mellitus is important risk factors for ischemic complications.

Bileaflet versus posterior-leaflet-only preservation in mitral valve replacement.

In the present study of mitral valve replacement, we investigated whether complete preservation of both leaflets (that is, the subvalvular apparatus) is superior to preservation of the posterior leaflet alone. Seventy patients who underwent mitral valve replacement in our clinic were divided into 2 groups: MVR-B (n=16), in whom both leaflets were preserved, and MVR-P (n=54), in whom only the posterior leaflet was preserved. The preoperative and postoperative clinical and echocardiographic findings were evaluated retrospectively. No signs of left ventricular outflow tract obstruction were observed in either group. In the MVR-B group, no decrease was observed in left ventricular ejection fraction during the postoperative period, whereas a significant reduction was observed in the MVR-P group (P=0.003). No differences were found between the 2 groups in their need for inotropic agents or intra-aortic balloon pump support, or in cross-clamp time, duration of intensive care unit or hospital stays, postoperative development of new atrial fibrillation, or mortality rates. Bileaflet preservation prevented the decrease in left ventricular ejection fraction that usually followed preservation of the posterior leaflet alone. However, posterior leaflet preservation alone yielded excellent results in terms of decreased left ventricular diameter. Bileaflet preservation should be the method of choice to prevent further decreases in ejection fraction and to avoid death in patients who present with substantially impaired left ventricular function.

Aortic Valve Regurgitation and Ventricular Septal Defect Diagnosed 5 Years after Penetrating Cardiac İnjury

Despite high mortality rates for penetrating heart injuries, developments in transport, diagnosis, and surgical interventions have increased survival rates. In some cases, life-threatening complications may be misdiagnosed or remain asymptomatic and lead to loss of life. Herein, we report a patient with aortic valve regurgitation because of noncoronary cusp perforation and ventricular septal defect that remained asymptomatic and diagnosed 5 years after a penetrating heart injury.

Impact of Surgeon Experience During Carotid Endarterectomy Operation and Effects on Perioperative Outcomes

Objective We evaluated the effect of surgeon experience on complication and mortality rates of carotid endarterectomy operation. Methods Fifty-nine consecutive patients who underwent carotid endarterectomy between January 2013 and February 2016 were divided into two groups. Patients who had been operated by surgeons performing carotid endarterectomy for more than 10 years were allocated to group 1 (experienced surgeons; n=34). Group 2 (younger surgeons; n=25) consisted of patients operated by surgeons independently performing carotid endarterectomy for less than 2 years. Both groups were compared in respect of operative results and postoperative complications. Results No intergroup difference was found for laterality of the lesion or concomitant coronary artery disease. In group 1, signs of local nerve damage (n=2; 5.9%) were detected, whereas in group 2 no evidence of local nerve damage was observed. Surgeons in group 1 used local and general anesthesia in 3 (8.8%) and 31 (91.2%) patients, respectively, while surgeons in group 2 preferred to use local and general anesthesia in 1 (4%) and 24 (96%) patients, respectively. Postoperative stroke was observed in group 1 (n=2; 5.9%) and group 2 (n=2; 5.8%). Conclusion Younger surgeons perform carotid endarterectomy with similar techniques and have similar results compared to experienced surgeons. Younger surgeons rarely prefer using shunt during carotid endarterectomy. The experience and the skills gained by these surgeons during their training, under the supervision of experienced surgeons, will enable them to perform successful carotid endarterectomy operations independently after completion of their training period.

Selective carotid endarterectomy and the advantages of conventional and eversion endarterectomy

Selective carotid endarterectomy (SCE) is described as the extraction of atheromatous plaque through an arteriotomy made starting from the common carotid artery and extending to the external carotid artery. The aim of the present study was to report the initial experience of SCE technique at our department.

The Comparison of Intravenous Patient Controlled Analgesia with Meperidine or Morphine for Pain Management after Thoracotomy

Yöntemler: Yüz kırk hasta (ASA I-III) prospektif çalışmada randomize olarak meperidin (Grup 1) ve morfin (Grup 2) gruplarına ayrıldı. Postoperatif ilk 24 saatteki İHKA kullanımı; Grup 1’de, 50 mg yükleme dozu, 7 mg sa-1 bazal infüzyon, 5 mg bolus dozunda Grup 2’de ise, 5 mg yükleme dozu, 0,5 mg sa-1 bazal infüzyon, 0,5 mg bolus dozunda uygulanırken, kilit zamanı 15’er dakikaydı. Toplanan veriler; sistolik, diastolik ve ortalama kan basınçları, kalp atım hızı, nabız oksimetresi satürasyonu, vizüel analog skala (VAS) ve Ramsey sedasyon skala değerleri, total ve ek analjezikler ile yan etkilerdi.