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Permanent URI for this collectionhttps://hdl.handle.net/11443/932
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Item Should transcatheter closure of atrial septal defects with inferior-posterior deficient rim still be attempted?(AME PUBL CO, 2019-01-01) Amedro, Pascal; Bayburt, Selin; Assaidi, Anass; Kreitmann, Bernard; Habib, Gilbert; Fouilloux, Virginie; Fraisse, AlainBackground: Transcatheter closure for atrial septal defect (ASD) with inferior-posterior rim deficiency has been scarcely reported with proper identification of the indications and limits. We aimed to assess the safety and feasibility of transcatheter closure of ASDs with deficient rims, paying particular attention to cases with inferior-posterior rim deficiency. Methods: From January 2008 to January 2013, 241 patients underwent transcatheter ASD closure, including 50 cases (20.7\%) with deficient rims, other than the anterior-superior one. Eighteen patients (12 females) presented inferior-posterior rim deficiency. Their median age was 8 (1.4-85) years and their median weight was 24 {[}9-97] kg. Transcatheter closure was performed in all cases under transesophageal echocardiography (TEE) guidance in children and intracardiac echocardiography (ICE) guidance in adults. Results: Out of 18 patients with inferior-posterior rim deficiency, only 8 underwent successful immediate transcatheter closure. Four cases failed to be closed. Major complications occurred in 6 patients, including 4 device embolizations, 1 pericardial effusion and 1 complete atrioventricular block that resolved after surgical removal of the device. During a median follow up of 54 +/- 13 months, a residual right-to-left shunt was documented in 2 more cases, requiring surgery in one case because of cyanosis. Transcatheter closure was successfully performed in the rest of the 223 patients, including in the 32 cases with deficient rims other than inferior-posterior. Conoluslons: Transcatheter closure of ASDs with inferior-posterior rim deficiency cannot be recommended.Item Extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest in children after cardiac surgery(TURKISH SOC CARDIOLOGY, 2017-01-01) Erek, Ersin; Aydin, Selim; Suzan, Dilek; Yildiz, Okan; Altin, Firat; Kirat, Baris; Demir, Ibrahim Halil; Odemis, EnderObjective: Extracorporeal membrane oxygenation (ECMO) is used to provide cardiorespiratory support during cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitationItem In vitro validation of a self-driving aortic-turbine venous-assist device for Fontan patients(MOSBY-ELSEVIER, 2018-01-01) Pekkan, Kerem; Aka, Ibrahim Basar; Tutsak, Ece; Ermek, Erhan; Balim, Haldun; Lazoglu, Ismail; Turkoz, RizaBackground: Palliative repair of single ventricle defects involve a series of open-heart surgeries where a single-ventricle (Fontan) circulation is established. As the patient ages, this paradoxical circulation gradually fails, because of its high venous pressure levels. Reversal of the Fontan paradox requires an extra subpulmonic energy that can be provided through mechanical assist devices. The objective of this study was to evaluate the hemodynamic performance of a totally implantable integrated aortic-turbine venous-assist (iATVA) system, which does not need an external drive power and maintains low venous pressure chronically, for the Fontan circulation. Methods: Blade designs of the co-rotating turbine and pump impellers were developed and 3 prototypes were manufactured. After verifying the single-ventricle physiology at a pulsatile in vitro circuit, the hemodynamic performance of the iATVA system was measured for pediatric and adult physiology, varying the aortic steal percentage and circuit configurations. The iATVA system was also tested at clinical off-design scenarios. Results: The prototype iATVA devices operate at approximately 800 revolutions per minute and extract up to 10\% systemic blood from the aorta to use this hydrodynamic energy to drive a blood turbine, which in turn drives a mixed-flow venous pump passively. By transferring part of the available energy from the single-ventricle outlet to the venous side, the iATVA system is able to generate up to approximately 5 mm Hg venous recovery while supplying the entire caval flow. Conclusions: Our experiments show that a totally implantable iATVA system is feasible, which will eliminate the need for external power for Fontan mechanical venous assist and combat gradual postoperative venous remodeling and Fontan failure.Item Outcomes of home mechanical ventilation with tracheostomy after congenital heart surgery(CAMBRIDGE UNIV PRESS, 2021-01-01) Temur, Bahar; Emre, Ismet E.; Aydin, Selim; Onalan, Mehmet A.; Basgoze, Serdar; Ozcan, Esra; Dogruoz, Alper; Erek, ErsinObjective: After congenital heart surgery, some patients may need long-term mechanical ventilation because of chronic respiratory failure. In this study, we analysed outcomes of the patients who need tracheostomy and home mechanical ventilation. Methods: Amongst 1343 patients who underwent congenital heart surgery between January, 2014 and June, 2018, 45 needed tracheostomy and HMV. The median age of these patients was 6.4 months (12 days-6.5 years). Nineteen patients underwent palliation while 26 patients underwent total repair. Post-operative diaphragm plication was performed in five patients (11\%). Median duration of mechanical ventilation before tracheostomy was 32 days (8-154 days). The patients were followed up with their home ventilators in ward and at home. Mean follow-up time was 36.24 +/- 11.61 months. Results: The median duration of ICU stay after tracheostomy was 27 days (range 2-93 days). Follow-up time in ward was median 30 days (2-156 days). A total of 12 patients (26.6\%) were separated from the ventilator and underwent decannulation during hospital stay. Thirty-two patients (71.1\%) were discharged home with home ventilator support. Of them, 15 patients (46.9\%) were separated from the respiratory support in median of 6 weeks (1 week-11 months) and decannulations were performed. Total mortality was 31.1\%. in which four patients are still HMV dependent. There was no significant difference for decannulation between total repair and palliation patients. Conclusion: HMV via tracheostomy is a useful option for the treatment of children who are dependent on long-term ventilation after congenital heart surgery although there are potential risks.Item Management of aortic arch hypoplasia in neonates and infants(WILEY, 2021-01-01) Onalan, Mehmet A.; Temur, Bahar; Aydin, Selim; Basgoze, Serdar; Guzelmeric, Fusun; Odemis, Ender; Erek, ErsinObjectives Surgical management of aortic arch hypoplasia (AAH) with associated intracardiac anomalies is a challenge in newborns. We reviewed the characteristics and outcomes of neonates and infants who underwent pulmonary artery banding concomitant to arch repair and single-stage total repair at our institution. Methods Medical records of 60 patients undergoing aortic arch reconstruction for AAH from 2014 to 2019 were retrospectively reviewed. Twenty-five patients were female (41.6\%), and the age of the patients ranged from 4 to 120 days (median, 19.5 days). The patients were divided into two groups: Group 1 (23 patients) underwent pulmonary artery banding concomitant to arch repair, and Group 2 (37 patients) underwent single-stage total repair in addition to arch repair. All arch repair procedures consisted of an extended (to the midportion of the ascending aorta) patch aortoplasty. Results Postoperative early mortality occurred in 12 patients, eight in Group 1 (34.8\%) and four in Group 2 (10.8\%). There was an early survival advantage in Group 2 (p = .019). Recoarctation occurred in 13 cases (21.6\%), and 11 (18.3\%) of them required reintervention (balloon angioplasty: 7, reoperation: 4). On univariate analysis, risk factors associated with death were pulmonary artery banding (hazard ratio {[}HR], 0.44