Kıvanç Atılgan

This study aims to compare the clinical outcomes of isolated aortic valve replacement using a sutureless bioprosthetic valve (Perceval) and Transcatheter Aortic Valve Implantation (TAVI). This single-center retrospective study evaluated 143 patients who underwent isolated surgical minimally invasive aortic valve replacement and TAVI procedures between January 2020 and February 2025. Demographic, intraoperative, and postoperative data as well as perioperative echocardiographic findings were analyzed and compared. The patients were divided into 2 groups: Sutureless (n = 73) and TAVI (n = 70). The Intensive care unit stay, intubation time, and hospital discharge time were significantly shorter in the TAVI group ( P < .05). The requirement for inotropic support was also lower (2.8% vs 24.1%, P < .001). At the 30-day follow-up, the TAVI group had significantly lower mean and maximum transvalvular gradient. The need for pacemaker implantation was significantly higher in the TAVI group ( P = .001). Pacemakers were implanted in 1.4% of patients in the sutureless group and 17.1% of patients in the TAVI group. The sutureless group had a significantly longer mean discharge time (5.47 ± 2.86 days) compared to the TAVI group (3.89 ± 2.93 days; P = .001). Similarly, intubation time was significantly longer in the sutureless group (11.90 ± 5.84 hours) compared to the TAVI group (3.37 ± 19.17 hours; P = .001). TAVI is a safe and effective alternative in appropriately selected patients, offering shorter operative times and improved early postprocedural recovery without compromising clinical or hemodynamic outcomes.

Background: To compare the clinical outcomes between isolated aortic valve replacement (AVR) using a conventional stented bioprosthetic valve (St. Jude, Epic™ Valve Porcine) and a sutureless bioprosthetic valve (Perceval). Methods: This single-center retrospective study evaluated 160 patients who underwent isolated surgical minimally invasive AVR between January 2020 and December 2024. Demographic, intraoperative, and postoperative data, as well as echocardiographic findings, were analyzed and compared. Results: Patients were divided into two groups: Perceval (n = 73) and St. Jude (n = 87). Patients in the Perceval group were older and had higher EuroSCORE 2 scores. The Perceval group showed significantly shorter cardiopulmonary bypass and aortic cross-clamp times (53.45 ± 24.18 vs. 68.02 ± 21.05 min; p < 0.001; and 40 ± 20.11 vs. 53.24 ± 17.34 min; p < 0.001). The intensive care unit (ICU) stay, intubation time, and hospital discharge time were significantly shorter in the Perceval group (p < 0.05). The requirement for inotropic support was also lower (2.8% vs. 24.1%, p < 0.001). At the 30-day follow-up, the perceval group had significantly lower mean and maximum transvalvular gradients. Complication rates were low in both groups, with one case of permanent pacemaker implantation and two reinterventions in the Perceval group. Conclusion: Sutureless AVR with a Perceval valve is a safe and effective alternative to conventional stented bioprostheses, particularly in elderly patients. It offers shorter operative times and improves early postoperative recovery without compromising the clinical or hemodynamic outcomes.

A 54-year-old, asymptomatic, disease-free female patient was operated for an incidentally detected left main coronary artery aneurysm (CAA) associated with fistula to a giant aneurysm associated with the right atrium (RA). The patient had an extremely rare left main CAA and a fistula connection of a giant aneurysm connecting to the RA.

Objective We examined cardiac surgery patients who underwent monitoring of postoperative vital parameters using medical monitoring devices which transferred data to a mobile application and a web-based software. Methods From November 2017 to November 2020, a total of 2340 patients were enrolled in the remote patient monitoring system after undergoing cardiac surgery. The medical devices recorded vital parameters, such as blood pressure, pulse rate, saturation, body temperature, blood glucose, and electrocardiography were measured via the Health Monitor DakikApp and Holter ECG DakikApp devices which reported data to web-based software and a mobile application (DakikApp Mobile Systems, Remscheid, Germany). During the follow-up period, patients were contacted daily through text and voice messages, and video conferences. Remote Medical Evaluations (RMEs) concerning patients' medical states were performed. Medication reminders, daily treatment were communicated to the patients with the DakikApp Mobile Systems Software. Results During a mean follow-up period of 78.9 ± 107.1 (10–395) days, a total of 135,786 patient contacts were recorded (782 video conferences, 2805 voice messaging, and 132,199 text correspondence). The number of RMEs handled by the Telemedicine Team was 79,560. A total of 105,335 vital parameter measurements were performed and 5024 hospital application requests (6.3% per RME) were addressed successfully and hospitalization was avoided. A total of 144 (6.1%) potentially life-threatening complications were found to have been diagnosed early using the Telemedicine System. Conclusion Remote Patient Monitoring Systems combined with professional medical devices are feasible, effective, and safe for the purpose of improving postoperative outcomes.

The incidence of postoperative recurrent coarctation of the aorta ranges from 5% to 50%, and largely depends on the age at initial repair. Due to the increased fibrosity and rigidity of the aorta in older age, stent placement is preferred instead of balloon angioplasty, resulting in an almost complete relief of the gradient in >95% of the patients. In patients with transverse arch hypoplasia, transcatheter intervention with further surgical intervention may be needed, and the use of stenting was shown to be effective in the treatment of patients with hypoplastic isthmus, arch or tubular coarctation. In this case of a late re-coarctation, we preferred to apply a hybrid technique for treatment. The first step of the treatment was debranching of the brachiocephalic and left common carotid arteries with upper mini median sternotomy. On the following day, the patient underwent a successful stent placement to the transvers arch.

Objective: The aim of this study is to define the correlation between intramyocardial left anterior descending artery (IMLAD) and coronary artery angiography (CAG); our clinical intraoperative experiences. Material and Methods: Between January 2014 and May 2019, 196 patients underwent coronary artery bypass grafting (CABG) surgery in Bozok University Medicine Faculty Hospital. The correlation between the typical “wide-U” image of left anterior descending artery (LAD) depression(Cicekcioglu sign) on CAG and our intraoperative surgical observations of the patients were studied. Results: Of the 196 patients, 5 were excluded due to the total occlusion of proximal LAD. 30 had a typical “wide-U” image(Cicekcioglu sign) on CAG and 22 were observed to have an IMLAD. Of the 25 patients being observed to have IMLAD intraoperatively, 3 had a normal preoperative CAG imaging. The prevalence of the IMLAD was 13%. Sensitivity of CAG was measured as 88% and specificity of CAG was 95.1%. Discussion: In CAG, in case of LAD composing a “wide-U” imaging(Cicekcioglu sign) the image of LAD course is often observed to have a correlation with the intraoperative detection of IMLAD.

Aim: Tricuspid valve replacement (TVR) has always been a compelling issue for cardiovascular surgeons due to the poor postoperative outcomes. Besides myocardial ischemia caused by aortic cross clamp, cardioplegia resulting in reperfusion injury is still one of the major problems in open heart surgery. In this study, we aimed to evaluate the benefits of TVR with beating heart (BH) in terms of decreasing mortality and morbidity rates among the patients with TAPSE indexes lower than 15 mm. Methods: This research was designed as a retrospective cohort study. Twenty-nine patients with isolated tricuspid valve diseases with a TAPSE index lower than 15 mm and who underwent TVR consecutively between 2006 and 2012 were enrolled in this study. Among 29 patients, 13 underwent TVR with cardioplegic arrest (AH group) and 16 underwent TVR with a beating heart (BH group). Results: There were 5 males in the AH group and 6 males in the BH group. The mean ages of the patients in AH and BH groups were 55.42 (11.6) years and 57.92 (8.43) years, respectively. Sixty-two percent of the AH group was in New York Heart Association (NYHA) Class III or IV heart failure in comparison to 56% of the BH group. Atrial fibrillation was present in 9 patients (69%) in the AH group and 11 patients (69%) in the BH group. Left ventricular functions were calculated as 57.23% (7.62) and 58.65% (8.02) in the AH and BH groups, respectively. Mean systolic pulmonary artery pressure was 38.45 (11.42) mmHg in AH group and 42.68 (13.01) mmHg in BH group. TAPSE score was 14.12 (1.78) in AH group and 13.67 (1.13) in BH group. Cardiopulmonary bypass times were 78.3 (19.8) minutes and 54 (14.6) minutes in the AH and BH groups, respectively, with respective total operation times of 167.4 (67.6) minutes and 132.2 (39.7) minutes (P=0.023). Positive inotropic drug use was observed in 9 patients (69%) in the AH group and in 7 patients (44%) in the BH group (P=0.029). The independent effect of BH in decreasing the mortality rates was calculated by logistic regression analysis (Odds ratio (OR) 0.43, 95% confidence interval (CI) 0.22–0.76, P=0.001). Conclusion: Operative and postoperative outcomes of the BH technique in TVR encourage us to recommend using the BH technique in TVR among patients with a TAPSE score lower than 15 mm. '+st+' Pfannmüller B, Davierwala P, Misfeld M, Borger MA, Garbade J, Mohr FW. Postoperative outcome of isolated tricuspid valve operation using arrested-heart or beating-heart technique. Ann Thorac Surg. 2012 Oct;94(4):1218-22. doi: 10.1016/j.athoracsur.2012.05.020. Epub 2012 Jun 28. Lee CH, Laurence DW, Ross CJ, Kramer KE, Babu AR, Johnson EL, et al. Mechanics of the Tricuspid Valve-From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling. Bioengineering (Basel). 2019 May 22;6(2).pii:E47. doi: 10.3390/bioengineering6020047. Ton-Nu TT, Levine RA, Handschumacher MD, Dorer DJ, Yosefy C, Fan D, et al. Geometric determinants of functional tricuspid regurgitation: insights from 3-dimensional echocardiography. Circulation. 2006 Jul 11;114(2):143-9. Song JM, Jang MK, Kim YJ, Kim DH, Kang DH, Song JK. Right ventricular remodeling determines tricuspid valve geometry and the severity of functional tricuspid regurgitation: a real-time 3-dimensional echocardiography study. Korean Circ J. 2010 Sep;40 (9):448-53. doi: 10.4070/kcj.2010.40.9.448. Epub 2010 Sep 30. Stuge O, Liddicoat J. Emerging opportunities for cardiac surgeons within structural heart disease. J Thorac Cardiovasc Surg. 2006 Dec;132(6):1258-61. Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation. 1967 Apr;35(4 Suppl):I63-9. Schmid E, Hilberath JN, Blumenstock G, Shekar PS, Kling S, Shernan SK, et al. Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel. 2015;7(2):151-8. Hasde AI, Ozcinar E, Cakici M, BaranC, Inan MB, Yazıcıoglu L, et al. Comparison of aortic cross-clamping versus beating heart surgery in tricuspid valve repair. Turkish Journal of Thoracic and Cardiovascular Surgery 2018;26(4):519-27. doi: 10.5606/tgkdc.dergisi.2018.16229 Di Mauro M, Bezante GP, Di Baldassarre A, Clemente D, Cardinali A, Acitelli A, et al. Functional tricuspid regurgitation: an underestimated issue. Int J Cardiol. 2013 Sep 30;168 (2):707-15. doi: 10.1016/j.ijcard.2013.04.043. Epub 2013 May 3. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006 Nov 1;174(9):1034-41. Landis RC, Brown JR, Fitzgerald D, Likosky DS, Shore-Lesserson L, Baker RA, et al. Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base. J Extra Corpor Technol. 2014 Sep;46(3):197-211. Narayan P, Rogers CA, Bayliss KM, Rahaman NC, Panayiotou N, Angelini GD, et al. On-pump coronary surgery with and without cardioplegic arrest: comparison of inflammation, myocardial, cerebral and renal injury and early and late health outcome in a single-centre randomised controlled trial. Eur J Cardiothorac Surg. 2011 May;39(5):675-83. doi: 10.1016/j.ejcts.2010.08.032. Rogers CA, Capoun R, Scott LJ, Taylor J, Jain A, Angelini GD, et al. Shortening cardioplegic arrest time in patients undergoing combined coronary and valve surgery: results from a multicentre randomized controlled trial: the SCAT trial. Eur J Cardiothorac Surg. 2017 Aug 1;52(2):288-96. doi: 10.1093/ejcts/ezx087. Ellenberger C, Sologashvili T, Kreienbühl L, Cikirikcioglu M, Diaper J, Licker M. Myocardial Protection by Glucose-Insulin-Potassium in Moderate- to High-Risk Patients Undergoing Elective On-Pump Cardiac Surgery: A Randomized Controlled Trial. Anesth Analg. 2018 Apr;126(4):1133-41. doi:...

Aim: Deep vein thrombosis (DVT) is a prevailing cause of serious complications such as pulmonary thromboembolism, venous ulcer, chronic venous insufficiency, venous gangrene and postthrombotic syndrome, and significantly increased hospitalization costs. The aim of this study is to determine the incidence of DVT and regional effects for its development as well as evaluate its distribution in terms of age and gender in Yozgat, a city with a population of more than 500.000 people, which is considered to fairly represent Central Anatolia with regards to geography, economy, industry, age distribution, morbidity and mortality. Methods: For this cross-sectional study, we included all DVT cases aged 15 years and older from Yozgat diagnosed in Bozok University, Faculty of Medicine, Research and Application Hospital and Yozgat State Hospital between September 2012-September 2016. Patients and diagnostic characteristics were retrieved from medical records. The distribution of DVT cases were evaluated in terms of age and gender according to the data derived from address-based population registration system of Turkish Statistical Institute (TUSI) 2016.Results: One thousand two hundred and eighty-seven patients were enrolled in this research. DVT incidence increased with age and substantially accelerated above the age of 40. The overall DVT incidence was 1:1000 persons per year and slightly higher among the female population (1:1000 persons/year vs 0.9:1000 persons/year) (P=0.924). According to TUSI 2016, the mean body mass index (BMI) of females was significantly higher than that of males (29.2 (5.3) kg/m² and 26.7 (3.6) kg/m², respectively, P<0.001). In the region comprising Yozgat, Sivas and Kayseri, labor-force participation rate of females and males were 28% and 49.6%, respectively, which was a significant regional risk factor for DVT development. Conclusion: It would be possible to decrease the incidence of DVT and the high hospitalization costs of related complications, most of which can be avoided with suitable prophylaxis based on more reliable results obtained from further research. Appropriate precautions should be taken after considering regional socioeconomic and sociocultural values.

The patients with end-stage renal disease have an increased risk of atherosclerosis and the probability of cardiovascular diseases. Due to the use of immunosuppressive agents, the patients having renal graft carry an additional risk of atherosclerosis or endocarditis. A 67-year-old male patient with a history of renal transplantation was referred to our hospital with a severe chest pain and dyspnea. After diagnosing severe ischemic coronary artery disease by coronary angiography, the patient underwent a successful operation of a single vessel coronary artery bypass grafting (CABG) in beating heart. Up to 20% of post-renal transplantation mortality is attributed to cardiovascular diseases. Graft rejection, the need of hemodialysis, perioperative infection are some of the major complications for renal transplant patients undergoing CABG surgery. Off-pump CABG (OPCABG) surgery is a less invasive technique in comparison with CABG with cardiopulmonary bypass (CPB), and protects the patient from negative effects of CPB such as complement system activation, inflammatory mediator secretion, thrombocytopenia, clotting disorders. We recommend to prefer OPCABG and have preoperative prophylaxis in order to avoid both perioperative infection and renal graft rejection in renal transplant patients undergoing CABG surgery.