Araştırma Çıktıları
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Item 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 UmitItem Robotic mitral valve replacement(AME PUBLISHING COMPANY, 2022-01-01) Arslanhan, Gokhan; Senay, Sahin; Kocyigit, Muharrem; Gullu, Ahmet Umit; Alhan, CemBackground: 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.Item 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, CemBackground: 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 femalesItem 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, CemBackground 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 2012Item Robotic mitral valve replacement for rheumatic mitral disease(AME PUBL CO, 2017-01-01) Senay, Sahin; Gullu, Ahmet Umit; Alhan, CemItem Hybrid treatment of type B aortic dissection with retrograde extension in a patient with anomalous aortic arch(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2018-01-01) Cacur, Orkun; Ozkan, Basak; Gullu, Ahmet Umit; Senay, Sahin; Alhan, CemHybrid treatment of aortic arch encompasses a combination of endovascular stenting with surgical revascularization of supra-aortic branches. Herein, we report a 53-year-old male case of type B aortic dissection with retrograde extension and anomalous aortic arch. The patient was successfully treated by hybrid treatment using bilateral carotico-subclavian bypass grafting and endovascular stent grafting.Item 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, CemBackground 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.Item 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, CemWe 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.Item 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, CemThe 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].Item 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, CemObjective: 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.