Browsing by Author "Kocyigit, Muharrem"

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A simple method for occlusion of both venae cavae in total cardiopulmonary bypass for robotic surgery
(OXFORD UNIV PRESS, 2012-01-01) Gullu, Ahmet Umit; Senay, Sahin; Kocyigit, Muharrem; Alhan, Cem
We describe a novel surgical technique for occlusion of the superior and inferior venae cavae which allows opening of the right atrium safely during robotic cardiac surgery.
An analysis of the learning curve for robotic-assisted mitral valve repair
(WILEY, 2021-01-01) Gullu, Ahmet U.; Senay, Sahin; Kocyigit, Muharrem; Zencirci, Ertugrul; Akyol, Ahmet; Degirmencioglu, Aleks; Karakus, Gultekin; Ersin, Egemen; Karabiber, Alara; Alhan, Cem
Background Many cardiac surgeons receive training for sternotomy-based cardiac surgical operations in residency programs and only a few education programs offer training specifically in minimally invasive cardiac surgery. In this report, we aimed to search and analyze the learning curve for robotic-assisted mitral valve (MV) repair in cardiac surgeons. Method Between January 2010 and July 2019, 60 robotic-assisted isolated MV repair surgeries were performed with DaVinci Robotic Systems in our center. Different kinds of surgical techniques were used. The assessment of the learning curve was based on cardiopulmonary bypass (CPB) and transthoracic aortic clamp (CC) times. Result There were 23 (38.3\%) men and 37 (61.7\%) women with a mean age of 48.3 years. The lesions of the MV were posterior leaflet prolapsus (n = 42, 70.0\%), anterior leaflet prolapsus (n = 8, 13.3\%), Barlow disease (n = 3, 5\%), and annular dilatation (n = 7, 11.6\%). The patients underwent notochordal implantation (n = 27, 45\%), quadrangular or triangular resection (n = 23, 38.3\%), isolated ring annuloplasty (n = 7, 11.7\%), resection, and leaflet reduction (n = 2, 3.3\%) or edge to edge repair (n = 1, 1.7\%). The maturation of the learning curve appeared to be about 30 cases. The statistical analysis showed that the mean CPB and CC times for the first 30 cases were greater compared with the 30 after learning curve (155.3 vs. 118.9 min {[}p = .00], 102.3 vs. 80 min {[}p = .00], respectively). There was no case of conversion to open surgery. No perioperative mortality was observed. Conclusion The maturation of the learning curve for robotic-assisted MV repair appeared to be about 30 cases in our group of patients. This study had encouraging results for surgeons who desire to start a robotic mitral surgery program.
Aortic valve reconstruction with autologous pericardium in a patient with osteogenesis imperfecta
(OXFORD UNIV PRESS, 2018-01-01) Gullu, A. Umit; Senay, Sahin; Ozkan, Basak; Kocyigit, Muharrem; Alhan, Cem
Cardiac valve surgery for patients with osteogenesis imperfecta is associated with a high incidence of complications such as perioperative bleeding and valve detachment. In this report, we present a patient who was diagnosed with osteogenesis imperfecta and severe aortic insufficiency and also discussed treatment options.
Application of cryoablation for the treatment of atrial fibrillation in patients undergoing cardiac surgery: Our mid-term results
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2018-01-01) Arnaz, Ahmet; Gullu, A. Umit; Akyol, Ahmet; Zencirci, Ertugrul; Senay, Sahin; Degirmencioglu, Aleks; Kocyigit, Muharrem; Alhan, Cem
Background: In this study, we aimed to present mid-term results of concomitant argon-based cryoablation in patients undergoing cardiac surgery. Methods: Between August 2014 and May 2016, 33 patients (17 males, 16 females
Comparative Effects of Blood and Crystalloid Cardioplegia on Cellular Injury and Oxidative Stress in Cardiovascular Surgery
(MEDICAL TRIBUNE INC, 2019-01-01) Ulugol, Halim; Aksu, Ugur; Kocyigit, Muharrem; Kilercik, Meltem; Karduz, Gulsum; Okten, Murat; Toraman, Fevzi
Purpose: The purpose of this study was to evaluate the effect of different cardioplegic solutions on endothelial integrity and oxidative stress in cardiovascular surgery. Methods: In this randomized prospective study, after ethics approval and informed consent, 60 surgical patients were included. Patients undergoing coronary bypass surgery were randomized into two groups as warm blood cardioplegia (n = 30) and cold crystalloid cardioplegia (n = 30) following the cross-clamping. Measurements were performed at three time points: before induction of anesthesia (Ti), at admission to intensive care unit (ICU) (T2) and at the 24th postoperative hour (T3). Besides biochemical routine hemodynamic monitoring, patients were assessed for the sialic acid (SA), ischemic-modified albumin (IMA), advanced oxide protein products (AOPPs), total thiol (SH), and free hemoglobin (fHb) level. Results: Neither crystalloid nor blood cardioplegia led to significant changes in the AOPPs, T-SH, and SA level (p >0.05). Crystalloid cardioplegia, however, increased IMA level compared to both baseline (p <0.01) and blood cardioplegia group (p <0.05). fHb levels were transiently increased in both groups at the second-time point (p <0.001). fHb level was lower in the crystalloid group compared to that in the other group (p <0.05) at T2. Conclusion: Cardioplegia type creates similar effects on glycocalyx integrity. However, myocardial protection could be provided with warm blood cardioplegia.
Did blood transfusion increase mortality in patients with diabetes undergoing isolated coronary artery bypass graft surgery? A propensity score-matched analysis of 816 patients
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2020-01-01) Kocyigit, Muharrem; Ulugol, Halim; Kiran, Seher Irem; Alhan, Cem; Toraman, Fevzi
Background: The aim of this study was to compare clinical outcomes of blood transfusion in patients with diabetes mellitus undergoing isolated on-pump coronary artery bypass grafting. Methods: The medical records of a total of 1,912 patients (1,300 males, 612 females
Long-term results of coronary surgery with endoscopic vein harvesting
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2021-01-01) Kilic, Leyla; Gullu, Ahmet Umit; Senay, Sahin; Ersin, Egemen; Celik, Ozlem; Guzel, Emine; Caliskan, Neriman Ozge; Kocyigit, Muharrem; Alhan, Cem
Background: In this study, we aimed to evaluate early and long-term outcomes of both isolated or concomitant coronary artery bypass grafting with the endoscopic vein harvesting technique. Methods: Between November 2012 and May 2017, a total of 324 patients (259 males, 65 females
Percutaneous cannulation for cardiopulmonary bypass in robotic mitral valve surgery with zero groin complications
(WILEY, 2022-01-01) Bastopcu, Murat; Senay, Sahin; Gullu, Ahmet U.; Kocyigit, Muharrem; Alhan, Cem
Introduction Robotic valve surgery utilizes the femoral vessels to set up cardiopulmonary bypass (CPB) which translates to groin wound and lower extremity vascular complications. A less invasive technique is a totally percutaneous bypass using vascular closure devices (VCDs) with concerns for lower limb ischemia and arterial stenosis. Since April 2018, we have adopted the standard use of total percutaneous CPB in our robotic mitral cases. We report our institutional results with this technique. Methods All consecutive patients who underwent robotic mitral valve surgery between April 2018 and December 2020 in our institution were included in our study. Hospital database data on demographics, operative variables, and surgical outcomes were recorded and analyzed. Results Robotic mitral valve surgeries were performed on 32 consecutive patients (mean age 57.2 +/- 14.8) between April 2018 and December 2020. None of our patients developed an infection at any site. Seroma, hematoma, or pseudoaneurysm were not observed at puncture sites. Surgical repair of the femoral vessels or an additional VCD was not necessary for any of our patients. Patients were followed up for a mean duration of 23.5 months. Our patients did not present with a late wound infection, a seroma, or a pseudoaneurysm, nor had complaints of limb ischemia or claudication. Conclusion Total percutaneous bypass is the least invasive method of establishing extracorporeal circulation for cardiac surgery and can be performed with excellent results. The benefits of robotic surgery can be expanded with better results in groin cannulation by the adoption of total percutaneous CPB.
Postoperative Atrial Fibrillation Reduced by Intraoperative and Postoperative Cell Saver System in Coronary Artery Bypass Graft Surgery
(AVES, 2022-01-01) Kocyigit, Muharrem; Kocyigit, Ozgen Ilgaz; Gullu, Ahmet Umit; Senay, Sahin; Alhan, Cem
Objective: Postoperative atrial fibrillation is commonly seen after cardiac surgery. One of the contributing factors is mediastinal shed blood and inflammation. Cell salvage techniques can reduce allogenic blood transfusion and reduce inflammation. The aim of this study was to investigate the reduction of postoperative atrial fibrillation by using the cell-salvage system. Methods: Patients who underwent isolated coronary artery bypass graft surgery (n = 498) were analyzed retrospectively in 2 groups. Postoperative atrial fibrillation group (n = 75) and non-postoperative atrial fibrillation group (n = 423). Preoperative and postoperative demographic and clinical data were compared between the 2 groups, respectively. Postoperative atrial fibrillation and possible contributing factors were analyzed with multinomial logistic regression analysis. Results: In the postoperative atrial fibrillation group, the patients' age and European System for Cardiac Operative Risk Evaluation (Euroscore) were higher than in the non-postoperative atrial fibrillation group (P = .001 and P = .003, respectively). Postoperative intensive care unit stay and hospital stay were longer in the postoperative atrial fibrillation group than in the non-postoperative atrial fibrillation group (P =.001 and P = .046, respectively). There were no statistical differences in mortality between groups. The incidence of postoperative atrial fibrillation decreased with the use of cell saver system and low Euroscore. Conclusion: The use of a cell salvage device intraoperatively and during the early postoperative period can decrease the incidence of postoperative atrial fibrillation group.
Replacement of the Ascending Aorta for Severe Atherosclerosis During Coronary Artery Bypass Surgery
(WILEY, 2012-01-01) Gullu, Ahmet Umit; Okten, Eyup Murat; Akay, Mehmet Hakan; Senay, Sahin; Kocyigit, Muharrem; Toraman, Fevzi; Karabulut, E. Hasan; Alhan, Cem
Background and Aim: In the present study, we investigated the benefit of ascending aorta replacement in patients with severe aortic atherosclerosis who undergo coronary artery bypass surgery (CABG). Methods: From January 2001 to April 2011, 3842 patients underwent CABG and in 36 of these patients (31 male, 5 female) the ascending aorta was replaced due to severe atherosclerosis. Total circulatory arrest was used in 22 patients (61\%). The patients were followed for 69 +/- 36 months (1-133 months) and compared to a control group of patients. The control group consisted of patients who underwent CABG with or without a concomitant procedure (n = 3806). Results: For the study group, the mean additive and logistic Euroscores of the patients were nine and 20, respectively. One stroke (2.8\%) was observed and this patient died in the early postoperative period. There were a total of four confirmed deaths (12\%) at any time point over the length of the follow-up among the patients who were discharged from the hospital. Two of them died of malignancy (lung and gastric tumors) and the other two from cardiac reasons. No patients had a stroke during follow-up. For the control group the mean age was 61 +/- 1, the stroke rate was 0.6\%, and the mortality rate was 0.96\%, and the mean logistic and additive Euroscores were 3.7 +/- 4.4, and 3.5 +/- 2.5, respectively. Conclusions: Replacement of highly calcified ascending aortas during CABG can be safely performed in selected patients with good long-term outcomes. doi: 10.1111/j.1540-8191.2012.01510.x (J Card Surg 2012
Robot-assisted mitral valve surgery without aortic cross-clamping: An alternative technique
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2021-01-01) Alhan, Cem; Senay, Sahin; Kocyigit, Muharrem; Kilic, Leyla; Celik, Ozlem; Whitham, Tarik; Gullu, Ahmet Umit
Robotic mitral valve replacement
(AME PUBLISHING COMPANY, 2022-01-01) Arslanhan, Gokhan; Senay, Sahin; Kocyigit, Muharrem; Gullu, Ahmet Umit; Alhan, Cem
Background: This study evaluates the clinical outcome of patients with robotic mitral valve replacement (MVR).Methods: Between January 2010 and April 2022, 117 consecutive patients underwent robotic MVR with or without additional cardiac procedures. All procedures were completed by a single surgical team with Da Vinci Robotic Systems. Perioperative variables and early clinical outcomes were recorded.Results: Mean age and EuroScore II of the patients were 57.1 +/- 12.9 and 5.1 +/- 5.7, respectively. Isolated MVR was performed in 55 (47.0\%) patients and combined cardiac procedures were performed in 62 (53.0\%) patients. Additional procedures included: ablation for atrial fibrillation, tricuspid valve replacement, tricuspid valve repair, left atrial appendix ligation, patent foramen ovale closure, left atrial thrombectomy and septal myectomy for hypertrophic obstructive cardiomyopathy. Mean cardiopulmonary bypass time and cross clamp time were 143 +/- 54 and 93 +/- 37 minutes, respectively. Mean intensive care unit stay time was 26.5 +/- 26.0 hours. Postoperative stroke was observed in one (0.9\%) patient and new onset renal failure was observed in two (1.7\%) patients. Perioperative and postoperative early mortality was observed in three (2.6\%) patients, which was lower than expected.Conclusions: Robotic MVR is feasible and can be performed with good early postoperative outcomes. A majority of the patients require additional cardiac procedures.
Robotic-assisted beating heart surgery provides precise repair of periprosthetic mitral valvular leak
(OXFORD UNIV PRESS, 2022-01-01) Kocyigit, Muharrem; Gullu, Ahmet Umit; Senay, Sahin; Alhan, Cem
The prosthetic paravalvular leak is a rare but important complication following mitral valve replacement. Determining the location of the leak is almost always dependent on perioperative transoesophageal echocardiography and the considerable expertise of echo operators. Acoustic shadowing due to the prosthetic valve may create another important difficulty. In this report, we present a case with a paravalvular leak diagnosed 1 year after mitral valve replacement. Beating heart surgery and robotic 3D/high-resolution camera provided to localize the direct location of leak coherent with perioperative echocardiography and precise repair. The robotic approach prevented the potential complications of aortic cross-clamp and resternotomy. The paravalvular leak is one of the most important complications of mitral valve replacement surgery with a prevalence of 2-13\% {[}1, 2].
Robotic-assisted cardiac surgery without aortic cross-clamping: A safe alternative approach
(WILEY, 2021-01-01) Gullu, Ahmet Umit; Senay, Sahin; Ersin, Egemen; Demirhisar, Onder; Whitham, Tarik; Kocyigit, Muharrem; Alhan, Cem
Background and Aim Attempting to place an aortic cross-clamp may complicate surgery and postoperative outcomes in patients who have mediastinal adhesions or in those with extensive aortic calcification. Although right-sided cardiac surgery via thoracotomy is not a new technique in these patients, robotic-assisted intracardiac repair without cross-clamping was not reported in a large group of patients previously. In this study, the safety of robotic-assisted cardiac surgery without aortic cross-clamping was examined. Methods From January 2010 to March 2020, 304 patients underwent robotic-assisted cardiac surgery in our center and in 25 of these patients (8.2\%) with a mean age of 65.5 +/- 20 years myocardial protection was succeeded with moderate hypothermic ventricular fibrillatory arrest. Severe pericardial adhesions or existence of highly calcified ascending aorta were the indications for fibrillatory arrest during robotic assistant surgery. Results Most patients were in New York Heart Association Class >= II (88.0\%) and the mean logistic Euroscore value was 18.5 +/- 22.3. The type of operations were mitral/tricuspid valve repair/replacement, cryoablation, atrial septal defect closure, and pericardiectomy. Cardiopulmonary bypass times were 141.5 +/- 47 (minimum 77-maximum 252) min. There was no case of conversion to open thoracotomy or sternotomy. Hemiparesis was observed in one patient. Two patients with 78.2 and 81.9 Euroscore values had mesenteric ischemia and multiorgan failure, respectively, and died at postoperative period. Conclusions Robotic-assisted cardiac surgery without cross-clamping may provide reasonable outcomes in patients with severe aortic calcification or mediastinal adhesions undergoing intracardiac repair. These acceptable outcomes may encourage surgeons to perform this approach in appropriate group of patients.
The feasibility of robotic-assisted concomitant procedures during mitral valve operations
(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2019-01-01) Gullu, Ahmet Umit; Senay, Sahin; Kocyigit, Muharrem; Okten, Eyup Murat; Dumantepe, Mert; Karabulut, Hasan; Alhan, Cem
Background: In this study, we present our clinical experience and midterm results with the robotic-assisted concomitant procedures during mitral valve operations. Methods: Between March 2010 and February 2018, a total of 34 patients (8 males, 26 females