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    A comparison of four different endovenous ablation techniques
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2017) Korkmaz, Kemal; Yener, Ali Umit; Genc, Serhat Bahadir; Gedik, Hikmet Selcuk; Budak, Ali Baran; Cagli, Kerim
    Background: This study aims to investigate the efficacy of radiofrequency ablation and endovenous laser ablation techniques and the impact on the quality of life of patients. Methods: Between October 2011 and October 2012, 472 extremities of a total of 368 patients (258 females, 110 males; mean age 41.2 years; range 24 to 62 years) who were admitted to our Cardiovascular clinic and underwent endovenous ablation for symptomatic varicose veins were included in the study. Of the patients, 1470 nm wavelength diode laser in 34.1% (n=161), 980 nm wavelength diode laser in 20.1% (n=95), radiofrequency ablation in 26.3% (n=124), and 1470 nm wavelength radial fiber laser in 26.3% (n=124) was applied. These techniques were compared in terms of the postoperative complications, complete occlusion, recanalization rates, and patient comfort. Results: Any major complication such as deep venous thrombosis, pulmonary embolism, and skin burn was observed in none of the patients. Postoperative pain and paresthesias were similar in the endovenous laser ablation groups. Radiofrequency ablation group had lesser postoperative pain and ecchymosis (n=9; n=2; p<0.05). Ecchymosis were mostly seen in 1470 nm wavelength radial diode laser group (n=12; p<0.05) and 980 nm wavelength diode laser group (n=15; p<0.05). At six months, recanalization was observed in the 1470 nm wavelength diode laser group (n=2) and in the 980 nm wavelength diode laser group (n=2). At one year, we observed recanalization in four patients in the radiofrequency ablation group, which did not statistical significance. Conclusion: Considering the same recanalization rates with endovenous laser ablation, lower need for tumescent anesthesia, effective use of thermal energy, and low complication rates, we recommend radiofrequency ablation technique in the treatment of superficial venous insufficiency.
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    Open Heart Surgery in a Newly Established Cardiovascular Department: The first 300 cases
    (Derman Medical Publ, 2015) Korkmaz, Kemal; Gedik, Hikmet Selcuk; Budak, Ali Baran; Genc, Serhat Bahadir; Lafui, Ayse; Yener, Ali Umit; Cagli, Kerim
    Aim: Evaluation of the results of open heart surgery in a newly established cardiovascular clinic: Ankara Numune Education and Research Hospital. Material and Method: Between June 2012 and January 2014, 300 open heart surgeries were performed. Urgent operation was performed in 22 patients (7.3%) because of ST-elevation myocardial infarction and in 1 patient because of left ventricular aneurysm rupture. Coronary artery bypass grafting was performed in 211 (70.3%) patients. The other patients underwent various complex operations such as valve repair, Tirone-David procedure and repair of atrioventricular canal defect. Results: In 3 patients (1%) hospital mortality was seen. Reoperation was performed in 8 patients (2.6%) because of pericardial tamponade and in 9 patients (3%) because of bleeding. Atrial fibrillation was developed in 28 patients (9.3%) in the postoperative period and normal sinus rhythm was established with medical cardioversion. Intraaortic balloon pump(IABP) was used in 4 patients preoperatively and in 11 patients postoperatively, including 15 patients(%5). Discussion: In the current era, the patients who are consulted to cardiovascular surgery clinics become more chronic, high risk and patients with additional co-morbid diseases because of the developments in interventional cardiology. Our newly established center aims to be a nationally and internationally successful clinic which was proved by low mortality and morbidity rates with a team who follows the developments and constantly educate and trained.
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    Protective role of heparin in the injury of the liver and kidney on the experimental model of ischemia/reperfusion
    (BMC, 2014) Yener, Ali Umit; Cicek, Mustafa Cuneyt; Genc, Serhat Bahadir; Ozkan, Turgut; Dogan, Emre; Bilgin, Bulent Caglar; Akin, Tezcan
    Background: Surgery of thoracoabdominal aortic aneurysms (TAAA) is associated with high incidence of serious complications. Ischemia/reperfusion (I/R) injury may be responsible for these complications. We investigated the effect of degree of anticoagulation on remote organ I/R injuries and whether heparin is protective against I/R injury in addition to its anticoagulant properties. Methods: Spraque Dawley rats were used to determine both liver and kidney concentrations of HSP-70, IL-6, MPO in four groups: ischemic control (operation with cross-clamping and intraperitoneal administration of 0.9% saline, n = 7), sham (operation without cross-clamping, n = 7), heparin (ACT level about 200), and high dose heparin (ACT level up to 600). Histological analyses of the organs were performed. Results: Histopathological evaluation of kidney presented significant differences between groups with regards to the cytoplasmic vacuole formation, hemorrhage, tubular cell degeneration and tubular dilatation while heparinized group had best results. The kidney MPO and HSP-70 levels significantly decreased (p < 0.05), but IL-6 level was not significant (p > 0.05) in heparinized group when compared to ischemic control group. No statistically significant intergroup differences were detected in the tissue samples of liver. Immunohistochemical markers of the liver were compared and no statistically significant difference was found among the groups. Conclusion: Heparin is an important anticoagulation agent in TAAA surgical procedures but the use of higher levels of heparin in the present study revealed no beneficial effects. Bleeding complications is much less when heparin is used in the real-world clinical practice as ACT levels of 200.
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    The effects of 21 and 23 milimeter aortic valve prosthesis on hemodynamic performance and functional capacity in young adults
    (2014) Yener, Ali Umit; Ozcan, Sedat; Budak, Ali Baran; Genc, Serhat Bahadir; Ozkan, Turgut; Cicek, Omer Faruk
    Objective: Early and medium-term improvement of functional capacity and regression of left ventricular hypertrophy was evaluated in the young adult patient group following application of 21 mm or 23 mm bileaflet aortic mechanical valve prosthesis due to aortic stenosis. Methods: Twenty two patients (10 male, 12 female; mean age 27+-8.2 (19-43)) who underwent isolated aortic valve replacement due to rheumatic aortic stenosis, were included in the study. 21 mm and 23 mm bileaflet mechanical prosthesis was used respectively in eight and fourteen patients. The mean body surface area was 1.86 m2 and 1.68 m2 respectively in 23 mm and 21 mm prosthesis while 1.73 ±0.25 m2 for the whole group. Functional capacity was New York Heart Association (NYHA) class II in 9 patients and class III in thirteen patients. Implantation was performed without enlarging the aortic root in all except four patients. In all patients transvalvular gradients, effective orifice area and the diameter of left ventricle were measured with transthoracic echocardiography during rest and after maximal exercise. Mean followup was 34±12 months (range 11-57 months). Results: There were no postoperative complications or deaths. All the patients were assessed as NYHA class I with regards to functional capacity (p=0.01). Significant improvements were determined in postoperative mean transvalvular gradient (p=0.005) and left ventricular mass index (p=0.01) when compared with preoperative values. Conclusion: Our findings show that replacement with 21 mm and 23 mm mechanical prosthesis provides a significant improvement in regression of symptoms and increase of functional capacity in young adults in early and mid-period without increasing mortality and morbidity.
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    The impact of coronary artery endarterectomy on mortality and morbidity during coronary artery bypass grafting
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Yener, Ali Umit; Kervan, Umit; Korkmaz, Kemal; Gedik, Hikmet Selcuk; Budak, Ali Baran; Genc, Serhat Bahadir; Ozkan, M. Turgut Alper
    Background: This study aims to investigate the effect of coronary endarterectomy (CE) on morbidity and mortality in patients undergoing concomitant coronary artery bypass grafting (CABG). Methods: We retrospectively reviewed 587 patients who underwent CABG surgery with concomitant CE (CABG+CE group) and patch plasty between March 2000 and April 2010. We compared these patients with randomly selected 600 patients who had undergone CABG surgery without CE (CABG only group) in the same period. A comprehensive evaluation of the groups was achieved by subgroup analysis with large series of parameters from patient files. Results: The patients in the CABG+CE group were older than the patients in the CABG only group (59.6 +/- 10.3 vs. 61.3 +/- 7.3; p<0.001). The incidence of atherosclerotic risk factors, triple-vessel disease, and complaints of unstable angina pectoris were slightly higher in CABG+CE group (p<0.05). Concomitant CE prolonged cross-clamp and cardiopulmonary bypass time. Also, postoperative total entubation time (12 +/- 10.3 vs. 12 +/- 7.4 hours; p<0.05) was significantly longer (p<0.05). The rates of myocardial infarction (p=0.006) and intra-aortic balloon pump requirement (p<0.001) were significantly higher in the CABG+CE group. The mortality rate did not differ between the two groups. Conclusion: Indication for CE must still be handled restrictively. Endarterectomy should be performed only on occluded, nearly occluded, and/or severely calcified vessels with long-range stenosis if regular anastomoses to these vessels seem to be technically impossible. Endarterectomy should not be considered as a substitute for CABG, and should be performed by an experienced surgical team. However, CE might not be associated with additional mortality compared to conventional coronary bypass surgery.