Adnan Yalcinkaya

Arteriyovenöz fistüller düşük enfeksiyon, tromboz, ikincil girişim ve kompliksyon oranlarıyla hemodiyaliz hastaları için yıllardır umut olmaktadır. Fakat arteriyovenöz fistüllerin uzun maturasyon süreleri (dört-altı hafta), matürasyonda yetersizlik, kanülasyonda zorluk ve zaman içinde venöz yapılarda anevrizma gelişimi gibi bazı dezavantajları vardır. Bu derlemede, arteriyovenöz fistül tanımı ve oluşum süreci, karşılaştırmalar, potansiyel sorunlar ve komplikasyonlara yönelik yönetim stratejileri ele alınmaktadır.

Background and Objectives: The aim of this study was to compare the effects of sevoflurane-based anesthesia and propofol-based total intravenous anesthesia (TIVA) on intraocular pressure (IOP) during coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CPB). Materials and Methods: This prospective observational monocentric study included 68 patients scheduled for CABG with CPB, divided into two groups of propofol-based TIVA (Group P) and sevoflurane-based anesthesia (Group S). Intraocular pressure was measured and recorded at eight predefined time points using a tonometer: before anesthesia induction (T1), 10 min after induction (T2), immediately before the beginning of CPB (T3), 3 min after the beginning of CPB (T4), 3 min after cross-clamping (T5), 3 min after cross-clamp removal (T6), immediately before the weaning of CPB (T7), and at the end of the surgery (immediately after skin closure) (T8). The primary endpoint was to examine the effects of propofol-based TIVA and sevoflurane-based anesthesia methods on IOP during CABG operation. The secondary endpoints included a comparison of hemodynamic variables, blood gas values, and intensive care unit (ICU) and hospital stays. Results: Intraocular pressure values were similar for both groups at all time points. A statistically significant decrease was found in IOP in all measurements after induction compared to pre-induction values in both Group P and Group S (p < 0.05). Compared to IOP measured at 10 min after induction, no statistically significant difference was found at all subsequent time points in both groups. When the right and left IOP values were compared, no statistically significant difference was detected at all time points in both Group P and Group S. Conclusions: The results of the study indicated that propofol-based TIVA and sevoflurane-based anesthesia had similar effects on IOP in patients undergoing CABG with CPB.

Aim: Chronic venous insufficiency (CVI) is a condition that results from obstruction, valve insufficiency, dysfunction of calf muscle pump, or their combinations. This study analyzed the risk factors and demographic characteristics of CVI in nurses in Türkiye. Additionally, it seeks to identify the total number of patients treated at medical centers in 2022 and assess the prevalence of CVI.Material and Methods: This multicenter, descriptive, and cross-sectional study was conducted with the participation of nurses working in 18 centers. Nurses completed a questionnaire that included their demographic information and venous insufficiency risk factors, and the Venous Insufficiency Epidemiological and Economic Study-Quality of Life Questionnaire. Researchers also completed the Standard CEAP Form Section C. The cases were divided into 2 groups: CVI (-) group (n=776, 43.5%) and CVI (+) group (n=1010, 56.5%). Results: A total of 1786 nurses participated in this study. Older age (>30-39 years), female gender, ≥2 pregnancies, ≥2 childbirths, years in the profession (>5-15 years), family history, and night cramps were identified as risk factors for CVI (p0.05). Hypertension, diabetes, and a history of deep vein thrombosis were the most common coexisting diseases. With a one-unit increase in age, risk of CVI increased 1.1-fold, family history of VV increased CVI risk 1.9-fold and presence of nocturnal night cramps increased risk of CVI 2.6-fold. The prevalence of CVI in 2022 was found to be 22.66% in this study.Conclusion: Older age, female gender, ≥2 pregnancies, ≥2 childbirths, years in the profession, family history, and night cramps are identified as risk factors for CVI in nurses. Common comorbid diseases include hypertension, diabetes, and a history of DVT. Pregnancy, particularly with multiple occurrences, stands out as a critical period for CVI. Reported symptoms in CVI (+) nurses include leg pain, swelling, heaviness, restless legs, and throbbing. Nurses demonstrate a higher incidence of CVI compared to other professions, highlighting an occupational risk. These findings stress the importance of preventive measures for nurses.

Background Today, repair techniques almost completely take place of the mitral valve replacement, especially in patients with degenerative disease. Majority of the surgeons hesitate to prefer repair in patients with bileaflet prolapse. In this study we aimed to investigate postoperative results of our patients with mitral valve insufficiency due to bileaflet prolapse and treated with repair techniques Methods 89 patients who underwent mitral valve repair by the same surgical team due to bileaflet prolapse, between January 2006 and January 2016 in Turkiye Yuksek Ihtisas Hospital were included to this study. Preoperative, operative and postoperative data such as mortality, recurrent mitral insufficiency, echocardiographic parameters and reoperation rates were investigated. Results Mean follow up duration was 25.3±17.7 months. Mean age was 46.6±17.4 years. According to the transthoracic echocardiographic evaluations, 8 (9%) patients had moderate and 81 (91%) patients had severe mitral insufficiency. When preoperative and postoperative values were compared statistically significant improvement in functional capacity of patients according to NYHA classification has been noted. (2.1±0.5 ; 1, , p=0.001) Improvements in left ventricular end diastolic diameter (5.5±0.7 cm ; 5±0.6 cm, p=0.001), left ventricular end sistolic diameter (3.8±0.6 cm ; 3.6±0.6 cm, p=0.004 ), left atrium diameter (4.8±0.9 cm ; 4.3±0.6 cm, p=0.001) and pulmonary artery pressure (44.3±13.4 mmHg; 32.1±5.4 mmHg, p=0.001) were statistically significant. Conclusions In the lights of findings about good postoperative results and durability rates, mitral valve repair can be safely used in patients with mitral valve insufficiency due to bileaflet prolapse especially with chordae replacement technique which can be feasible after improvements in suture technologies.

Gümünüzde kardiyologlar ve kardiyovasküler cerrahlar birden çok komorbiditeye ve kardiyovasküler hastalığa sahip hasta grubuyla daha sık karşılaşmakta. Perkutan ve cerrahi teknikler bu hastalarda tek başına başarı sağlayamamakta veya yüksek riskli olmakta. İki yöntemin güçlü yönlerini hibrid bir şekilde kullanarak bu hastalarda düşük riskli prosedürler gerçekleştirilebilmektedir. Gelişen teknoloji ile birlikte miyokardiyal revaskülarizasyon, kalp kapak hastalıkları, aort ve periferik damar hastalıkları için yeni hibrid prosedürler oluşturulabilmektedir.

Backgrounds Postoperative atrial fibrillation (POAF) is one of the most common complication of cardiac surgery. Epicardial fat tissue may play a role in the development of atrial fibrillation (AF). The aim of this study was to evaluate relationship between epicardial fat volume (EFV) and the appearance of new-onset AF in patients undergoing isolated coronary artery bypass graft (CABG) with normal echocardiographic functions. Methods Between January 2017 and June 2020, 281 coronary artery disease patients undergone isolated CABG surgery with normal echocardiographic functions were included in the study. Patient characteristics, medical history, and perioperative variables were retrospectively collected. Patients with AF predisposition factors were excluded. Results Sixty-seven patients (23.8%) developed postoperatively AF during hospital stay. In univariate analysis, patients with postoperative AF were older compared with sinus rhythm patients (60.78 ± 9.03 vs. 65.46 ± 9.22, p = 0.001). There are no statistically significant differences between groups and EFV compared (107.78 ± 41.04 vs. 106.66 ± 34.98 p = 0.84). Large left atrial diameter, female patient, cardiopulmonary bypass and longer cross-clamp time showed correlation between POAF without statistical significance. Conclusion Aging is the only associated factor with AF in this study. There was no EFV difference between POAF and non-AF groups in patients undergoing isolated CABG with normal echocardiographic functions.

BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavailability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, S pO ₂ 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations.

Article Citation: Adnan Yalcinkaya, Adem Ilkay Diken, Tolga Dogan, Kadriye Memic, Seyhan Yilmaz, and Kerim Cagli (2016) Starr-Edwards Caged-Ball Mitral Valve: Still Working after 41 Years. Texas Heart Institute Journal: February 2016, Vol. 43, No. 1, pp. 96-97. doi: http://dx.doi.org/10.14503/THIJ-14-4558