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-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 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, CemIntroduction 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.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.Item 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, FevziBackground: 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 femalesItem 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, CemBackground: 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