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Item Association between renin-angiotensin-aldosterone system inhibitor treatment, neutrophil-lymphocyte ratio, D-Dimer and clinical severity of COVID-19 in hospitalized patients: a multicenter, observational study(SPRINGERNATURE, 2021-01-01) Gormez, Selcuk; Ekicibasi, Erkan; Degirmencioglu, Aleks; Paudel, Ashok; Erdim, Refik; Gumusel, Hilal Kurtoglu; Eroglu, Elif; Tanboga, Ibrahim Halil; Dagdelen, Sinan; Sariguzel, Nevin; Kirisoglu, Ceyda Erel; Pamukcu, BurakThe aim of this study was to investigate the possible relationship between worse clinical outcomes and the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in hospitalized COVID-19 patients. A total of 247 adult patients (154 males, 93 femalesItem Comparison of hypertension prevalence and the use of renin-angiotensin-aldosterone system blockers in hospitalized patients with COVID-19 and non-COVID-19 viral pneumonia(AVES, 2021-01-01) Gormez, Selcuk; Kirisoglu, Ceyda Erel; Ekicibasi, Mehmet Erkan; Degirmencioglu, Aleks; Paudel, Ashok; Akan, Gokce; Atalar, Fatmahan; Sariguzel, Nevin; Pamukcu, BurakObjective: To compare the prevalence of hypertension and pre-existing use of renin-angiotensin-aldosterone system blockers in patients with coronavirus disease (COVID-19) and non-COVID-19 viral pneumonias. Methods: Real-time polymerase chain reaction confirmed COVID-19 and non-COVID-19 pneumonia patients were retrospectively analyzed. The presence of hypertension, coronary artery disease (CAD), and pre-existing use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were compared between the groups. Results: A total of 103 COVID-19 and 91 non-COVID-19 hospitalized viral pneumonia patients were enrolled. Hypertension and CAD were more common in patients with non-COVID-19 viral pneumonia than in patients with COVID-19 (39.6\% vs 22.3\%, respectively, p=0.012 and 24.2\% vs 4.9\%, respectively, p<0.001). In our study, 2.9\% and 6.8\% of patients with COVID-19 were on ACEIs and ARBs, respectively, whereas 13.2\% and 19.8\% of patients with non-COVID-19 viral pneumonia were on ACEIs and ARBs, respectively (p=0.009 and p=0.013). Neutrophil-to-lymphocyte ratio (p<0.001) was prominent in patients with non-COVID-19 viral pneumonia compared with patients with COVID-19. Conclusion: Our study results indicate that hypertension and CAD are more common among patients with non-COVID-19 viral pneumonia than patients with COVID-19. The prevalence of ACEIs and ARBs use was not higher in patients with COVID-19. Our results support that the use of ACEIs and ARBs do not play a specific role in patients with COVID-19.Item Rise of serum troponin levels following uncomplicated elective percutaneous coronary interventions in patients without clinical and procedural signs suggestive of myocardial necrosis(TERMEDIA PUBLISHING HOUSE LTD, 2016-01-01) Buturak, Ali; Degirmencioglu, Aleks; Surgit, Ozgur; Demir, Ali Riza; Karakurt, Huseyin; Erturk, Mehmet; Yazici, Selcuk; Serteser, Mustafa; Norgaz, Tugrul; Gorgulu, SevketIntroduction: The new definition of periprocedural myocardial infarction (type 4a MI) excludes patients without angina and electrocardiographic or echocardiographic changes suggestive of myocardial ischemia even though significant serum troponin elevations occur following percutaneous coronary intervention (PCI). Aim: To evaluate the incidence and predictors of serum troponin rise following elective PCI in patients without clinical and procedural signs suggestive of myocardial necrosis by using a high-sensitivite troponin assay (hsTnT). Material and methods: Three hundred and four patients (mean age: 60.8 +/- 8.8 years, 204 male) undergoing elective PCI were enrolled. Patients with periprocedural angina, electrocardiographic or echocardiographic signs indicating myocardial ischemia or a visible procedural complication such as dissection or side branch occlusion were excluded. Mild-moderate periprocedural myocardial injury (PMI) and severe PMI were defined as post-PCI (12 h later) elevation of serum hsTnT concentrations to the range of 14-70 ng/l and > 70 ng/l, respectively. Results: The median pre-procedural hsTnT level was 9.7 ng/l (interquartile range: 7.1-12.2 ng/l). Serum hsTnT concentration elevated (p < 0.001) to 19.4 ng/l (IQR: 12.0-38.8 ng/l) 12 h after PCI. Mild-moderate PMI and severe PMI were detected in 49.3\% and 12.2\% of patients, respectively. Post-procedural hsTnT levels were significantly higher in multivessel PCI, overlapping stenting, predilatation and postdilatation subgroups. In addition, post-procedural hsTnT levels were correlated (r = 0.340Item The Effect of Mild Left Ventricular Diastolic Dysfunction on Outcome After Isolated Coronary Bypass Surgery(2020-01-01) Degirmencioglu, Aleks; Senay, Sahin; Gullu, Umit; Karakus, Gultekin; Zencirci, Ertugrul; Buturak, Ali; Ugur, Murat; Gemici, Gokmen; Akyol, Ahmet; Celik, Seden Erten; Alhan, CemItem Elective percutaneous coronary intervention leads to significant changes in serum resistin, leptin, and adiponectin levels regardless of periprocedural myocardial injury: an observational study(AVES, 2016-01-01) Buturak, Ali; Degirmencioglu, Aleks; Bayrak, Fatih; Kiris, Tuncay; Karakurt, Huseyin; Demir, Ali Riza; Surgit, Ozgur; Erturk, MehmetObjective: Bioactive roles of adipokines in coronary atherosclerosis and acute coronary syndromes have been demonstrated previously. Ho-wever, there is a lack of data regarding the relationship between serum adipokines and periprocedural myocardial injury (PMI) following elective percutaneous coronary intervention (PCI). Therefore, we aimed to investigate the association between serum adipokines and PMI related to elective PCI. Methods: In total, 153 consecutive patients (aged 60.6 +/- 8.2 years, 98 men) with stable angina pectoris undergoing elective PCI were enrolled in this observational cross-sectional study. Serum resistin, leptin, adiponectin, and high-sensitive Troponin T (hscTnT) levels were measured immediately before PCI and after 12-h PCI. The no-injury, PMI, and type 4a myocardial infarction (type 4a MI) groups were defined as groups consisting patients with post-procedural hscTnT concentrations < 14 ng/L, between 14-70 ng/L, and > 70 ng/L, respectively. Results: Serum hscTnT, resistin, and leptin concentrations significantly (p<0.001) increased while serum adiponectin levels decreased (p<0.001) after 12-h elective PCI. However, no correlation was found between post-procedural hscTnT concentrations and resistin, leptin, and adiponectin levels. The no-injury group consisted of 65 patients (42.4\%), whereas PMI and type 4a MI were observed in 70 (45.8\%) and 18 (11.8\%) patients, respectively. The average pre-procedural and post-procedural resistin, leptin, and adiponectin levels did not show any significant difference in the no-injury, PMI, and type 4a MI groups. Conclusion: There is no correlation between serum adipokine levels and post-procedural troponin elevations reflecting PMI or type 4a MI. However, serum resistin and leptin levels increase, whereas adiponectin levels decrease significantly after elective PCI.Item The long-term incidence and predictors of radial artery occlusion following a transradial coronary procedure(VIA MEDICA, 2014-01-01) Buturak, Ali; Gorgulu, Sevket; Norgaz, Tugrul; Voyvoda, Nuray; Sahingoz, Yusuf; Degirmencioglu, Aleks; Dagdelen, SinanBackground: Radial artery occlusion (RAO) is an infrequent complication of transradial coronary procedures (TRA). To our knowledge, there is no satisfactory data regarding the late term incidence and predictors of RAO in the literature. Our aim was to establish the long-term incidence of radial artery occlusion and investigate its predictors. Methods: This was a single center prospective study. A total number of 409 consecutive patients undergoing their first TRA were recruited. Clinical and procedural data were all recorded. Doppler ultrasound examination was performed at 6-15 months following the intervention. Results: RAO was detected in 67 patients and 342 patients maintained radial artery patency. The overall RAO incidence was 16.4\% at late term. Patients with RAO were younger than the patients with patent radial arteries (55.9 +/- 9.7 vs. 59.1 +/- 9.4 years, p = 0.014). The incidence of RAO in hypertensive patients (9.8\%) was lower (p < 0.001) than the observed incidence (23\%) in non-hypertensive patients. RAO group had higher rate (28\%, p = 0.027) of post-procedural access site pain. Regression analysis revealed that hypertension was negative while post-procedural access site pain was positive independent predictors for RAO. In addition, the relative risk for RAO also increased significantly (p < 0.001) when the ratio of sheath/artery diameter (S/A) was > 1. Conclusions: The present study reveals that the long-term incidence of RAO is 16.4\%. Hypertension, post-procedural access site pain and S/A ratio > 1 are independent predictors of RAO at late term.Item Catheter entrapment due to severe radial artery spasm during transradial approach(VIA MEDICA, 2016-01-01) Zencirci, Ertugrul; Degirmencioglu, AleksBackground: Catheter entrapment due to severe radial artery spasm (RAS) during transradial coronary catheterization has been rarely reported and its management is not precisely defined. The aim of this study was to determine the incidence, predictors and management of catheter entrapment due to severe RAS. Methods: A total of 723 patients undergoing transradial coronary catheterization at a single center were retrospectively enrolled in the present study. Patients were divided into two groups: those with catheter entrapment due to severe RAS and those without. Results: The incidence of catheter entrapment was 0.8\%. Height (161.2 +/- 9.1 cm vs. 169.6 +/- +/- 10 cm, p = 0.047) and body surface area (1.86 +/- 0.04 vs. 1.95 +/- 0.18, p = 0.002) were found to be lower, and total procedure time 33.2 +/- 13.4 min vs. 15.2 +/- 12.3 min, p < 0.001) was longer in the entrapment group. Multivariate logistic regression analysis demonstrated that total procedure time independently predicted catheter entrapment (odds ratio: 1.057, 95\% confidence interval {[}CI] 1.004-1.114, p = 0.035). Receiver-operating characteristic curve demonstrated good diagnostic accuracy for prolonged total procedure time in predicting catheter entrapment (area under curve = 0.8, 95\% CI 0.63-0.97, p = 0.01). Patients were effectively treated with stepwise administration of systemic vasodilators, forearm heating, sedation and as a last resort general anesthesia with no significant complication. Conclusions: Catheter entrapment due to severe RAS during transradial approach was rare and prolonged total procedure time is an independent predictor of catheter entrapment. Treatment with stepwise administration of different treatment modalities is possible with no significant complication.Item 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, CemBackground: 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 femalesItem 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, CemBackground 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.