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Öğe Assessing volumetric changes in abdominal aortic aneurysms following endovascular repair(Clinics Cardive Publ Pty Ltd, 2021) Gunerhan, Yalcin; Isik, Mehmet; Dereli, Yuksel; Tanyeli, Omer; Kadiyoran, Cengiz; Iyisoy, Mehmet Sinan; Gormus, NiyaziObjective: Volumetric changes in the aneurysm sac were evaluated following endovascular aortic repair (EVAR) in intact abdominal aortic aneurysm (AAA) patients who underwent EVAR. Methods: Fifty-two patients, who underwent EVAR from 2015 to 2019, were analysed retrospectively. A total of 158 computed tomography angiography scans was examined by performing reconsctructive volumetric calculations. Total aneurysm volume (TAV), patent lumen volume (PLV) and thrombus-coated aneurysm wall volume (TCAWV) were calculated. The results obtained at six, 12 and 24 months postoperatively were compared with those of the pre-operative period. Results: Mean TAV had regressed 7% by the sixth month (p = 0.1), 27% by the 12th month (p = 0.0003) and 19% by the 24th month (p = 0.0008). Mean TCAWV had increased 2% by the sixth month (p = 0.3), and regressed 26% by the 12th month (p = 0.3) and 14% by the 24th month (p = 0.8). Mean PLV had regressed by 20% by the sixth month (p = 0.008), 29% by the 12th month (p = 0.0002) and 26% by the 24th month (p = 0.0006). For each individual proximal, middle and distal measurement, regression was observed at six and 12 months; however, an increase was observed at 24 months compared to the previous follow ups. Conclusion: The expansion measurements of TAV in the 24th month support the doubts on the medium- to long-term results of EVAR. The largest regression in the aneurysm sac was observed in the distal portion, then in the proximal portion, and the least regression was observed in the middle section.Öğe Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups(Forum Multimedia Publishing, Llc, 2021) Isik, Mehmet; Velioglu, YusufObjective: The aim of this study was to contribute to the issue of Who should we perform Doppler ultrasonography on? and determine the contribution of comorbid diseases to the development of carotid artery stenosis (CAS) and pre-operative CAS by examining comorbid diseases in patients undergoing coronary artery bypass graft operation (CABG) and also discussing the effect of carotid stenosis levels on postoperative stroke. Method: Between 2011-2015, a total of 921 patients who underwent cardiac surgery retrospectively were examined. Of these, 594 CABG patients aged 60 and over who underwent preoperative carotid Doppler examination were analyzed. Results: Sixty-five percent of patients were male, and 35% were female. The mean age was 69.3 years. Sixty-nine percent of patients were in the 0-29% stenosis group, 12.9% in the 30-49% group, 14.6% in the 50-69% group, 3% in the 70-99% group, and 0.3% in the 100% occlusion group. Peripheral artery disease (PAD), age, gender, and diabetes mellitus (DM) were found to have significant (P < 0.05) effects on the occurrence of CAS. CAS increased by 0.9% with an increase of one year in age, 10.8% with the presence of PAD, 3% with male sex, 3.8% with presence of chronic obstructive pulmonery disease (COPD), 1.9% with presence of left main coronary disease (LMCAD), and 0.9% with presence of hypertension. In the decision tree analysis, the rate of 50% and above CAS in the presence of PAH + DM and age older than 65 years was 62.5%. Cerebrovascular accident (CVA) distribution was 2.1% in the 0-29% group, 2.5% in the 30-49% group, 4.5% in the 50-69% group, and 11.1% in the 70-99% group. Postoperative CVA was not observed in 10 patients who underwent carotid endarterectomy (CE). Postoperative CVA developed in six patients with 50% or more stenosis who did not undergo CE. Conclusion: For the preoperative detection of CAS in patients undergoing CABG, the association of advanced age, PAD, DM, male gender, COPD, LMCAD, and hypertension risk factors should be considered. We suggest that carotid screening should be performed in those over 65 years of age and with PAD+DM. Studies with large populations are needed to observe the effects of aortic atherosclerosis load, surgical procedure, and unilateral/bilateral CAS presence on the development of stroke in patients with severe CAS and postoperative CVA.Öğe Contribution of Current Comorbid Conditions to Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass and Stroke Distribution in Carotid Artery Stenosis Groups(Forum Multimedia Publishing, Llc, 2021) Isik, Mehmet; Velioglu, YusufObjective: The aim of this study was to contribute to the issue of Who should we perform Doppler ultrasonography on? and determine the contribution of comorbid diseases to the development of carotid artery stenosis (CAS) and pre-operative CAS by examining comorbid diseases in patients undergoing coronary artery bypass graft operation (CABG) and also discussing the effect of carotid stenosis levels on postoperative stroke. Method: Between 2011-2015, a total of 921 patients who underwent cardiac surgery retrospectively were examined. Of these, 594 CABG patients aged 60 and over who underwent preoperative carotid Doppler examination were analyzed. Results: Sixty-five percent of patients were male, and 35% were female. The mean age was 69.3 years. Sixty-nine percent of patients were in the 0-29% stenosis group, 12.9% in the 30-49% group, 14.6% in the 50-69% group, 3% in the 70-99% group, and 0.3% in the 100% occlusion group. Peripheral artery disease (PAD), age, gender, and diabetes mellitus (DM) were found to have significant (P < 0.05) effects on the occurrence of CAS. CAS increased by 0.9% with an increase of one year in age, 10.8% with the presence of PAD, 3% with male sex, 3.8% with presence of chronic obstructive pulmonery disease (COPD), 1.9% with presence of left main coronary disease (LMCAD), and 0.9% with presence of hypertension. In the decision tree analysis, the rate of 50% and above CAS in the presence of PAH + DM and age older than 65 years was 62.5%. Cerebrovascular accident (CVA) distribution was 2.1% in the 0-29% group, 2.5% in the 30-49% group, 4.5% in the 50-69% group, and 11.1% in the 70-99% group. Postoperative CVA was not observed in 10 patients who underwent carotid endarterectomy (CE). Postoperative CVA developed in six patients with 50% or more stenosis who did not undergo CE. Conclusion: For the preoperative detection of CAS in patients undergoing CABG, the association of advanced age, PAD, DM, male gender, COPD, LMCAD, and hypertension risk factors should be considered. We suggest that carotid screening should be performed in those over 65 years of age and with PAD+DM. Studies with large populations are needed to observe the effects of aortic atherosclerosis load, surgical procedure, and unilateral/bilateral CAS presence on the development of stroke in patients with severe CAS and postoperative CVA.Öğe The cost analysis of varicose vein treatment techniques in Turkey: a benefit or profit problem? Cost analysis of varicose vein treatment(Derman Medical Publ, 2018) Tanyeli, Omer; Isik, MehmetAim: Varicose veins are common healthcare problem in Turkey and worldwide. In this study, we compared the economic parameters of commonly used varicose treatment techniques, particularly classical surgical techniques, endovenous radiofrequency ablation (RFA) and glue (cyanoacrylate) techniques' costs, hospital bills, and profits. Material and Method: A total of 100 patients who had varicose vein operations, were evaluated retrospectively between April 2017 and November 2017. These patients were divided into subgroups depending on the methods used such as classical surgical treatment or catheter-based techniques. Demographic data including age, gender, hospitalization period, cost of the patient, amounts billed to SGK, and the patient-based profit/loss was analyzed for groups of varicose vein treatments described above. Results: Twenty-nine patients (29%) were treated by surgery and 71 patients (71%) received catheter-based treatments. Thirty-four patients (34%) were treated by glue injection. and 37 patients (37%) were treated by RFA There was no difference between the groups for the length of hospital stay (p > 0.05). The glue group had the highest cost (2093.8 +/- 148.9 TL) while the surgery group had the lowest cost (618.2 +/- 365.4 TL), with the RF group in between (1453.1 +/- 130.3) (p < 0.001). The RF group had the highest profit for the hospital (209.9 +/- 261.3 TL), while the glue group had the lowest profit (-66.3 +/- 126.2 TL) (p<0.001). Discussion: The most suitable strategy seems to be RFA when profit is a concern. But the patient's wishes, anatomical properties, activity/working conditions and the physician's choice for the welfare of the patient should be determinative.Öğe Early Surgical Results of Patent Ductus Arteriosus in Premature Infants(Gazi Univ, Fac Med, 2018) Altinbas, Ozgur; Ozer, Abdullah; Isik, Mehmet; Sarigul, Ali; Ege, ErdalObjective:Our aim is to evaluate the closure of patent ductus arteriosus through surgery at an early stage, commonly seen in premature infants and a leading cause of left-to-right shunt and mortality/morbidity, as a safe modality to prevent complications that may develop in postnatal preiod in patients with bronchopulmonary displasia or respiratory distress syndrome followed up in mechanical ventilation, and whose ductus arteriosus can not be closed despite medical treatment. Material and Methods:Thirty two cases of patent ductus arteriosus with premature birth history and no additional cardiac pathology, performed in the Department of Cardiovascular Medical School, Necmettin Erbakan University between 2006-2015 were included into the study. Results:Of the 32 patients, 14 (43,7%) were females and 18 (56,3%) were males. The most frequently seen preoperative disorder was respiratory distress syndrome(n=20). Twenty-two (68%) of the patients were following as intubated in newborn intensive care unit. Surgical procedure was performed in patients whose ductus were not closed via medical treatmentorin whom medical treatment was contraindicated for problems such as intracranial hemorrhage, renal failure or thrombocytopenia. Excitus rate was 15,6% (n=5) in our series. Removal time of mechanical ventilation was average 6,2 days. Postoperative echocardiography showed no recurrence of patent ductus arteriosus. Conclusion:Prevention of postnatal mortality and morbidity due to patent ductus arteriosus in premature infants can be achieved by early surgical closure during postnatal early period before secondary organ failure due to shunting develops and infants with critical general status-dependent on mechanical vantilation-,and for whom medical treatment is unsuccessful.Öğe Early Surgical Results of Patent Ductus Arteriosus in Premature Infants(Gazi Univ, Fac Med, 2018) Altinbas, Ozgur; Ozer, Abdullah; Isik, Mehmet; Sarigul, Ali; Ege, ErdalObjective:Our aim is to evaluate the closure of patent ductus arteriosus through surgery at an early stage, commonly seen in premature infants and a leading cause of left-to-right shunt and mortality/morbidity, as a safe modality to prevent complications that may develop in postnatal preiod in patients with bronchopulmonary displasia or respiratory distress syndrome followed up in mechanical ventilation, and whose ductus arteriosus can not be closed despite medical treatment. Material and Methods:Thirty two cases of patent ductus arteriosus with premature birth history and no additional cardiac pathology, performed in the Department of Cardiovascular Medical School, Necmettin Erbakan University between 2006-2015 were included into the study. Results:Of the 32 patients, 14 (43,7%) were females and 18 (56,3%) were males. The most frequently seen preoperative disorder was respiratory distress syndrome(n=20). Twenty-two (68%) of the patients were following as intubated in newborn intensive care unit. Surgical procedure was performed in patients whose ductus were not closed via medical treatmentorin whom medical treatment was contraindicated for problems such as intracranial hemorrhage, renal failure or thrombocytopenia. Excitus rate was 15,6% (n=5) in our series. Removal time of mechanical ventilation was average 6,2 days. Postoperative echocardiography showed no recurrence of patent ductus arteriosus. Conclusion:Prevention of postnatal mortality and morbidity due to patent ductus arteriosus in premature infants can be achieved by early surgical closure during postnatal early period before secondary organ failure due to shunting develops and infants with critical general status-dependent on mechanical vantilation-,and for whom medical treatment is unsuccessful.Öğe Early-Term Outcomes of Off-Pump versus On-Pump Beating-Heart Coronary Artery Bypass Surgery(Georg Thieme Verlag Kg, 2019) Velioglu, Yusuf; Isik, MehmetBackground The current study analyzed and compared early-term outcomes of off-pump versus on-pump beating heart coronary artery bypass surgery. Methods From January 2011 to January 2018, a total of 736 patients underwent isolated first-time elective beating-heart coronary artery bypass surgery without the use of aortic cross-clamping and cardioplegic arrest at our institution, and they were included in this study. Data of patients were collected and retrospectively analyzed. Patients were divided into two groups according to the use of cardiopulmonary bypass during the operation, as off-pump group ( n = 399) and on-pump beating-heart group ( n = 337). Both groups were compared with each other in terms of preoperative, intraoperative, and postoperative data. Results Groups were statistically similar with regard to baseline clinical characteristics and demographics. When compared with off-pump group, on-pump beating-heart group had a greater number of distal bypass, longer length of hospital stay, and lower postoperative hematocrit level, and received more blood product transfusion. No statistically significant differences were detected between the groups with respect to mortality and postoperative complications except for atrial fibrillation. Atrial fibrillation was significantly frequent in on-pump beating-heart group. Conclusion Our study suggested that off-pump and on-pump beating-heart coronary artery bypass procedures had similar early mortality and major complication rates except for atrial fibrillation. However, it seemed that off-pump procedure was superior to on-pump beating-heart procedure with regard to length of hospital stay, blood product transfusion, and atrial fibrillation development. Further prospective randomized studies with larger patient series are needed to support our research and attain more accurate data.Öğe Evaluation of post-operative flow and diameter changes in brachial and ulnar arteries in coronary artery bypass surgery patients in which the radial artery is used as graft(Turkish Soc Cardiology, 2015) Isik, Mehmet; Yuksek, Tahir; Dereli, Yuksel; Gormus, Niyazi; Durgut, Kadir; Koc, OsmanObjective: The radial artery is widely used in coronary bypass surgery. In these patients, forearm and hand circulation is provided by the ulnar artery. This study aimed to investigate post-operative changes in flow and diameter in brachial and ulnar arteries in patients undergoing coronary bypass surgery in which the radial artery is used as graft. Methods: Between September 2007 and September 2008, 20 patients (16 men, 4 women; mean age 57.8 years; range 44 to 70 years) underwent elective coronary bypass surgery at our clinic. The radial artery was used as graft in all cases. Pre-operatively, adequacy of the ulnar artery for forearm circulation was investigated by Allen test and duplex ultrasonography. Basal flow and diameter values of the brachial and ulnar arteries were measured. Control duplex ultrasound measurements were performed at three months post-operatively. Flow and diameter changes in the brachial and ulnar arteries were recorded. Results: Significant increase was shown in ulnar artery flow and diameter values in post-operative measurements. A significant increase was observed in brachial artery diameter, accompanied by a relative decrease in flow value. There were no mortality or ischemic complications in our study. Transient paresthesia as a neurological complication was observed in 4 patients. Conclusion: Radial artery use for coronary bypass surgery leads to significant changes in ulnar and brachial arteries. All flow and diameter changes can be detected by color Doppler ultrasonography in the early stages. These adaptation mechanisms show that the radial artery can be safely harvested as graft material.Öğe Giant left atrial capillary haemangioma invading left-main coronary artery(Oxford Univ Press, 2021) Yildirim, Serkan; Isik, Mehmet; Tanyeli, Omer; Gormus, NiyaziCardiac haemangiomas are rare cases and can be seen at any age of life. A 49-year-old woman was admitted to our hospital with chest pain. A well-circumscribed soft tissue mass extending from the pulmonary artery truncus to the left ventricular inferior neighborhood. Following surgical resection, the patient was discharged 4 days after surgery.Öğe Investigation of left ventricular changes according to valve type in patients with surgical replacement due to isolated aortic stenosis(Clinics Cardive Publ Pty Ltd, 2023) Guener, Abdullah; Isik, Mehmet; Tanyeli, Oemer; Yildirim, Serkan; Ege, Erdal; Taban, Volkan BurakObjective: The aim of this study was to investigate postoperative left ventricular changes [left ventricular mass (LVM), left ventricular mass index (LVMI), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), patient-prosthesis mismatch (PPM), pulmonary artery pressure (PAP), gradients, and ejection fraction (EF)] according to the valve type used in patients undergoing aortic valve replacement (AVR) due to isolated aortic stenosis. Methods: A total of 199 patients with isolated AVR due to aortic stenosis between 2010 and 2020 was retrospectively investigated. Four groups were identified according to the valve type used (mechanical, bovine pericardium, porcine and sutureless). Pre-operative and first year postoperative transthoracic echocardiography findings for the patients were compared. Results: Mean age was 64.4 +/- 13.0 years, while the gender distribution was 41.7% women and 58.3% men. Of the valves used in patients, 39.2% were mechanical, 18.1% were porcine, 8.5% were bovine pericardial and 34.2% were sutureless valves. Analysis independent of the valve groups observed LVEDD, LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI values reduced significantly postoperatively (p < 0.001). EF was observed to increase by 2.1% (p = 0.008). Comparisons of the four valve groups revealed that LVEDD, LVESD, maximum gradient, mean gradient, LVM and LVMI significantly decreased in all groups. EF significantly increased only in the sutureless valve group (p = 0.006). Analysis of PPM groups showed that LVESD, maximum gradient, mean gradient, PAP, LVM and LVMI were significantly reduced in all groups. In the normal PPM group, there was an improvement in EF, which was significantly different to the other groups (p = 0.001), while in the severe PPM group, EF appeared to be reduced (p = 0.19).Öğe Management of Cardiac Surgery in a Pandemic Region Hospital: Precautions, Results and Experiences During COVID-19(Aves, 2021) Isik, Mehmet; Yildirim, Serkan; Dereli, Yuksel; Tanyeli, Omer; Gormus, NiyaziObjective: The aim of the present study was to share the experiences gained from emergency and semi-emergency cases of open heart surgery performed during the COVID-19 outbreak in Necmettin. Erbakan University Meram Medical Faculty Hospital, which was defined as a pandemic hospital by Turkish Ministry of Health and provided third degree health services. Materials and Methods: A total of 54 patients were retrospectively analyzed between 23 March and 22 May 2020, who were diagnosed to have aortic dissection, coronary artery disease, and heart valve diseases. Results: Thirty-two CABG, 12 valve surgery, 6 aortic surgery, 4 CABG + valve surgeries were performed. During the postoperative follow-up of I I patients, who were suspicious of COVID-19, 8 of them displayed respiratory problems and partial oxygen depletion and required continuous positive airway pressure. The hospitalization duration of COVID-19-suspicious patients were approximately 5 days longer than that of normal patients. In one of the patient, who was treated positive for COVID-19, acute coronary syndrome developed and CABG was performed following the treatment. Conclusion: During the pandemic period, acute cardiac diseases needing urgent surgery could be misdiagnosed because of similar symptoms with COVID-19 and the health care practitioners concentrated with the COVID-19 primarily. On the other hand, pandemic fear could cause delayed admission to the hospital and increased postoperative mortality and morbidity. When a COVID-19 positive or -suspicious patient undergo open-heart surgery, problems resulting from both COVID-19 infection and cardiopulmonary bypass-associated systemic effects could arise. The combination of these two cases could worsen the complications.Öğe Predictive Value of Neutrophil-to-Lymphocyte, Aspartate-to-Alanine Aminotransferase, Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratios in Severity and Side of Carotid Artery Stenosis: Are Those Significant?(Forum Multimedia Publishing, Llc, 2021) Altinbas, Ozgur; Demiryurek, Seniz; Isik, Mehmet; Tanyeli, Omer; Dereli, Yuksel; Gormus, NiyaziBackground: Atherosclerosis is a chronic disease that leads to mortality and morbidity by affecting arterial vascular structures. Carotid artery is one of these arterial structures and occlusive disease of carotid artery may cause stroke or cranial ischemic infarction. Inflammation plays a role in the atherosclerotic process. In this study, we aimed to discuss the relationship between the severity and side of carotid artery occlusion and novel inflammatory parameters include platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios. Methods: One-hundred-fifteen patients who had carotid artery stenosis between 50%-99% and 115 healthy subjects with no carotid artery stenosis or additional disease were included in the study. The relationship between the side and degree of the lesion and platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios were studied in the patient group. The patients with carotid artery stenosis and the healthy subjects were compared, in the terms of same parameters. Data were evaluated statistically. Results: There were no statistically significant differences between the groups, in the terms of platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios and the degree of stenosis. There was no statistically significant difference between the sides of the lesions and the parameters above except lymphocyte-to-monocyte ratio. It was statistically significantly higher in left-sided lesions. Aspartate-to-alanine aminotransferase and neutrophil-to-lymphocyte ratios were markedly higher in the patient group, when compared to controls. Conclusion: Platelet-to-lymphocyte, neutrophil-tolymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios are inexpensive, easy, fast, and reproducible parameters that can be used in determining the prediction of carotid artery stenosis.Öğe Predictive Value of Neutrophil-to-Lymphocyte, Aspartate-to-Alanine Aminotransferase, Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratios in Severity and Side of Carotid Artery Stenosis: Are Those Significant?(Forum Multimedia Publishing, Llc, 2021) Altinbas, Ozgur; Demiryurek, Seniz; Isik, Mehmet; Tanyeli, Omer; Dereli, Yuksel; Gormus, NiyaziBackground: Atherosclerosis is a chronic disease that leads to mortality and morbidity by affecting arterial vascular structures. Carotid artery is one of these arterial structures and occlusive disease of carotid artery may cause stroke or cranial ischemic infarction. Inflammation plays a role in the atherosclerotic process. In this study, we aimed to discuss the relationship between the severity and side of carotid artery occlusion and novel inflammatory parameters include platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios. Methods: One-hundred-fifteen patients who had carotid artery stenosis between 50%-99% and 115 healthy subjects with no carotid artery stenosis or additional disease were included in the study. The relationship between the side and degree of the lesion and platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios were studied in the patient group. The patients with carotid artery stenosis and the healthy subjects were compared, in the terms of same parameters. Data were evaluated statistically. Results: There were no statistically significant differences between the groups, in the terms of platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios and the degree of stenosis. There was no statistically significant difference between the sides of the lesions and the parameters above except lymphocyte-to-monocyte ratio. It was statistically significantly higher in left-sided lesions. Aspartate-to-alanine aminotransferase and neutrophil-to-lymphocyte ratios were markedly higher in the patient group, when compared to controls. Conclusion: Platelet-to-lymphocyte, neutrophil-tolymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios are inexpensive, easy, fast, and reproducible parameters that can be used in determining the prediction of carotid artery stenosis.Öğe Relationship Between Cardiac Surgery and Acute Ischemic Stroke: An Examination in Terms of Clinical, Radiological, and Functional Outcomes and Possible Pathophysiological Mechanisms(Forum Multimedia Publishing, Llc, 2021) Isik, Mehmet; Kozak, Hasan Huseyin; Gormus, NiyaziAim: The aim is to discuss the clinical characteristics, time, anatomical vascular distribution, radiological features, functional outcomes after stroke and possible pathophysiological mechanisms of acute ischemic stroke (AIS) that develop after cardiac surgery. Method: A total of 3,474 patients, who underwent cardiac surgery between 2015-2020, retrospectively were analyzed. Forty-nine patients, who developed AIS and had brain CT and diffusion MR images during hospitalization, were included in the study. Results: AIS distribution was at 53% CABG, 12.2% isolated mitral valve, 8.1% isolated aortic valve, and 26.5% combined surgical procedures. Patients with a <= 2 days (P = 0.03) preop preparation time and body surface area (BSA) of <1.85 m2 (P = 0.02) had a high discharge rate. While newly developing AF was low in the early stroke group, it was higher in the late stroke group (P = 0.02). A history of previous cerebrovascular events was found in 3.3% of the patients. Postoperative new AIS was detected in 7.8% of those with a history of cerebrovascular events. Total anterior circulation infarction (TACI) case rate was 8.1%, partial anterior circulation infarction (PACI) 12.2%, posterior circulation infarction (POCI) 24.4%, cortical border zone infarction (CBZI) 30.6%, combined POCI + CBZI 12.2%, multiple territorial infarcts (MTI) 10.2%, and lacunar circulation infarction (LACI) rate was 2%. The modified Rankin Scale means following AIS was 3.45. The worst Rankin score was 5.75 in CABG+MVR cases; it was found to be 5 in the valve + ascending aorta case and 5 in the five bypass cases. Conclusion: Calculation of cerebrovascular reserve with extra/intracranial vascular imaging is important in patients with multiple risk factors, whose association with stroke has been determined before cardiac surgery. We believe that cardiovascular surgery and neurology multidisciplinary prospective randomized studies should be conducted to obtain pre-, peri-and post-procedural risk calculation scales, according to cardiac surgery type and to reshape surgical procedures accordingly.Öğe Relationship Between Cardiac Surgery and Acute Ischemic Stroke: An Examination in Terms of Clinical, Radiological, and Functional Outcomes and Possible Pathophysiological Mechanisms(Forum Multimedia Publishing, Llc, 2021) Isik, Mehmet; Kozak, Hasan Huseyin; Gormus, NiyaziAim: The aim is to discuss the clinical characteristics, time, anatomical vascular distribution, radiological features, functional outcomes after stroke and possible pathophysiological mechanisms of acute ischemic stroke (AIS) that develop after cardiac surgery. Method: A total of 3,474 patients, who underwent cardiac surgery between 2015-2020, retrospectively were analyzed. Forty-nine patients, who developed AIS and had brain CT and diffusion MR images during hospitalization, were included in the study. Results: AIS distribution was at 53% CABG, 12.2% isolated mitral valve, 8.1% isolated aortic valve, and 26.5% combined surgical procedures. Patients with a <= 2 days (P = 0.03) preop preparation time and body surface area (BSA) of <1.85 m2 (P = 0.02) had a high discharge rate. While newly developing AF was low in the early stroke group, it was higher in the late stroke group (P = 0.02). A history of previous cerebrovascular events was found in 3.3% of the patients. Postoperative new AIS was detected in 7.8% of those with a history of cerebrovascular events. Total anterior circulation infarction (TACI) case rate was 8.1%, partial anterior circulation infarction (PACI) 12.2%, posterior circulation infarction (POCI) 24.4%, cortical border zone infarction (CBZI) 30.6%, combined POCI + CBZI 12.2%, multiple territorial infarcts (MTI) 10.2%, and lacunar circulation infarction (LACI) rate was 2%. The modified Rankin Scale means following AIS was 3.45. The worst Rankin score was 5.75 in CABG+MVR cases; it was found to be 5 in the valve + ascending aorta case and 5 in the five bypass cases. Conclusion: Calculation of cerebrovascular reserve with extra/intracranial vascular imaging is important in patients with multiple risk factors, whose association with stroke has been determined before cardiac surgery. We believe that cardiovascular surgery and neurology multidisciplinary prospective randomized studies should be conducted to obtain pre-, peri-and post-procedural risk calculation scales, according to cardiac surgery type and to reshape surgical procedures accordingly.Öğe Treatment Approaches to Combined Orthopedic and Vascular Traumas: A Single-Center Experience(Zamensalamati Publ Co, 2021) Dereli, Yuksel; Isik, Mehmet; Tanyeli, Omer; Yildirim, Serkan; Altinbas, Ozgur; Korucu, Ismail Hakki; Taban, Volkan BurakBackground: Orthopedic and vascular trauma can be clinically observed and have negative consequences if not treated appropriately. Objectives: This study aimed to present the clinical experiences of the authors regarding vascular traumas in combination with extremity fractures or dislocations. Methods: In total, 95 patients (78 males, 17 females, with the mean age of 34.7 +/- 5.6 years old) who underwent surgical treatment for combined orthopedic and vascular trauma between November 2012 and February 2020 were included in the study. Patients were retrospectively evaluated according to their clinical properties, treatment strategies, and results. Results: Traffic accidents were the most common reason for trauma with a rate of 36.8% (n=35). The most common orthopedic injury was seen in the femur, whereas the most common vascular injury was on the superficial femoral artery. The most commonly performed treatment methods for vascular and orthopedic trauma were primary repair and external fixation, respectively. Based on findings, the mortality and amputation rates were 2.1% (n=2) and 15.7% (n=15), respectively. Conclusion: Combined orthopedic vascular traumas are less frequent than isolated vascular traumas, but they have higher mortality and amputation rates. In order to decrease mortality and amputation rates, communication should be perfectly coordinated between the emergency department and orthopedic and cardiovascular surgery clinics; moreover, urgent intervention is crucial.
