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    Coronary artery bypass surgery in patients with severe left ventricular dysfunction
    (ELSEVIER IRELAND LTD, 2003) Isbir, CS; Yildirim, T; Akgun, S; Civelek, A; Aksoy, N; Oz, M; Arsan, S
    Objective: The role of coronary artery bypass grafting (CABG) in patients with severe left ventricular dysfunction was evaluated. Methods: Two hundred and twelve patients (152 men, 60 women; age 35 to 82, mean 55) with ejection fraction (EF) of less than 30% underwent CABG between January 1996 and February 2001 by a single surgeon (SA). They compromised of 12% of 1759 patients operated on in this period. EF ranged from 17% to 30% (mean 25%). Preoperatively 68% had congestive heart failure and 72% had severe angina (CCS 3 or 4). A left main lesion was found in 26% of the cases. The mean number of grafts was 3.18 per patient. The left internal mammary artery (LIMA) was used on 107 patients (50.4%). Preoperative intraaortic balloon pump (IABP) was used on 32 patients (15%). Endarterectomy was performed on 53 patients (25%). The patients were followed for up to 58 months (mean 28.7). Results: Twelve patients died in hospital (5.6%). Survival was 94%, 87%, 80% and 73% at 1, 2, 3 and 4 years respectively. Among the preoperative variables survival was negatively affected by chronic renal failure, older age, congestive heart failure, elevated pulmonary artery pressure and recent myocardial infarction, by means of multivariate analysis. Preoperative IABP support improved the operative mortality significantly (P=0.002). Use of LIMA did not have any influence on survival. Conclusion: CABG on patients with poor left ventricular function: (1) Can be performed with an acceptable mortality. (2) Mid term results are encouraging. (3) Preoperative IABP support improves the chance of survival. (C) 2003 Elsevier Ireland Ltd. All rights reserved.
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    Delayed rupture of a postinfarction left ventricular true aneurysm
    (ELSEVIER SCIENCE INC, 2004) Arsan, S; Akgun, S; Turkmen, M; Kurtoglu, N; Yildirim, T
    Delayed rupture of a true left ventricular aneurysm is a rare clinical condition. We report a case of a 60-year-old woman who underwent emergency surgical repair of a ruptured true aneurysm of the left ventricular inferior wall 3 months after the myocardial infarction. The repair consisted of endoaneurysmorraphy patch technique. The patient made a satisfactory recovery. (C) 2004 by The Society of Thoracic Surgeons.
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    FK506 to prevent lung injury after hindlimb ischemia and reperfusion in a rat model: An electron microscopic study
    (SPRINGER, 2004) Akgun, S; Tekeli, A; Isbir, SC; Civelek, A; Ak, K; Sirvanci, S; Arbak, S; Yaylim, I; Arsan, S
    Purpose. Hindlimb ischemia and reperfusion leads to lung injury in various animal models. We investigated the effectiveness of FK506, an immunosuppressive agent, which also modulates neutrophilic infiltration, in preventing lung injury after hindlimb ischemia and reperfusion in a rat model. Methods. Twenty-seven male Sprague-Dawley rats were randomized to received FK506 at doses of 0.3 mg/kg, 0.5 mg/kg, or 1 mg/kg body weight per day, or normal saline injections, as pretreatment, and there was also a sham group. On the 4th day, the animals were subjected to 2 h of ischemia induced by a tourniquet, followed by reperfusion of the extremities for 2 h. Lung tissue assays were performed for the lipid peroxidation product malondialdehyde (MDA) and total glutathione (GSH). Lung tissues were also examined histopathologically under light and electron microscopy. Results. The MDA levels in the study groups were significantly lower than those in the control group (P < 0.05), but the total GSH levels did not differ significantly among the groups. Histopathologically, there were no significant differences among the groups given different doses of FK506, but there was a significant difference between the control group and all the treatment groups. Conclusion. FK506 ameliorates the lung injury associated with ischemia and reperfusion of the lower limbs, and might have an inhibitory effect on the neutrophils that cause remote organ damage.
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    A mediastinal false aneurysm with aortocutaneous fistula
    (FORUM MULTIMEDIA PUBLISHING, LLC, 2004) Arsan, S; Yildirim, T; Akgun, S; Kurtoglu, N
    In this report, we present a case of the development of a false aneurysm of the ascending aorta with an aortocutaneous fistula in a 57-year-old patient 10 months following aortic valve replacement and concomitant coronary bypass surgery.
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    Missed diagnosis of unruptured, huge left ventricular pseudoaneurysm
    (FUTURA PUBL CO, 2003) Akgun, S; Keser, N; Yildirim, T; Arsan, S
    We report a case of a huge left ventricular pseudoaneurysm following myocardial infarction. Early after myocardial infarction, the pseudoaneurysm was missed during the cardiac examination. The patient underwent coronary bypass surgery with endoaneurysmorraphy of the pseudoaneurysm, and made a satisfactory recovery.
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    Neuroprotective effects of FK-506, L-carnitine and azathioprine on spinal cord ischemia-reperfusion injury
    (OXFORD UNIV PRESS INC, 2004) Akgun, S; Tekeli, A; Kurtkaya, O; Civelek, A; Isbir, SC; Ak, K; Arsan, S; Sav, A
    Objective: In our experimental study, we aimed to test the effect of FK506, azathioprine and L-carnitine on protection of spinal cord injury due to ischemia-reperfusion. Methods: Twenty-seven Spraque-Dawley male rats were randomly divided into five groups. They were subjected to spinal cord ischemia by clamping the abdominal aorta for 45 min. Thirty minutes before the aortic clamping, group I received 0.5 mg/kg FK506, group II received 100 mg/kg L-carnitine, group III received 4 mg/kg azathioprine, the fourth group was the control group and received only normal saline injection intravenously and the last group was the sham group. Neurological status was scored by using the Tarlov scoring system. Sections of the lumbar cord were harvested for histopathological grades (1-4), having regard to percentage of the apoptotic cells. Results: Hind-limb motor function had recovered normally 48 h after the operation in all rats which received FK506, azathioprine and L-carnitine prophylactically. In contrast, all rats in the control group had deteriorated to paraplegia by 48 h after the operation (P < 0.05). Histopathologic sections in the involved spinal cord segment showed that a greater number of motor neuron cells were preserved and there were less apoptotic cells in the rats that received FK506, azathioprine and L-carnitine than those in control group. Conclusions: These results suggest that prophylactic use of FK506, azathioprine and L-carnitine protects motor neuron cells from ischemic spinal cord injury. (C) 2003 Elsevier B.V. All rights reserved.
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    Reduction aortoplasty and external wrapping for moderately sized tubular ascending aortic aneurysm with concomitant operations
    (ELSEVIER SCIENCE INC, 2004) Arsan, S; Akgun, S; Kurtoglu, N; Yidirim, T; Tekinsoy, B
    Background. Replacement of the ascending aorta with a prosthetic graft is the preferred surgical procedure for an ascending aortic aneurysm. The choice of external wrapping of the aorta is a simple, fast, and effective method for moderately sized ascending aortic aneurysms with concomitant operations. In this study, we present the midterm results of 62 patients undergoing reduction aortoplasty with external wrapping and different cardiac procedures. Methods. The study group consisted of 48 male and 14 female patients with a mean age of 59.3 +/- 6.0 years. Measurement of the ascending aorta diameters was obtained at three points: before surgery, during the early postoperative period, and during the follow-up. The mean preoperative aortic diameter was 52.7 +/- 0.5 mm. In all patients, the ascending aortic aneurysm was repaired by reduction aortoplasty with external wrapping. Results. Mean follow-up time was 39.6 +/- 18.0 months. There was only one mortality (1.6%) as a result of septic multiple-organ failure and no major surgical complications in the 30-day postoperative period. Reduction aortoplasty of the ascending aorta with external wrapping resulted in a significant reduction of the ascending aorta in all patients (p = 0.000). There was an increase in the mean aortic diameter during the follow-up period (p = 0.000). Although this increase was statistically significant, all measurements of the follow-up period were still within normal range. Conclusions. External wrapping of the aorta offers excellent results with very low mortality and morbidity, and it can be regarded as a safe and effective method for the treatment of ascending aortic aneurysm in selected patients. However, the patients should be carefully monitored for redilatation after the procedure. (C) 2004 by The Society of Thoracic Surgeons.
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    Simultaneous carotid endarterectomy and myocardial revascularization by using cardiopulmonary bypass for both procedures
    (TAYLOR & FRANCIS LTD, 2005) Yildirim, T; Koksal, C; Kiniklioglu, H; Arsan, S
    Objective - The optimal treatment of patients with co-existing occlusive coronary and carotid arterial disease is controversial. This study reports our experience with simultaneous carotid endarterectomy and coronary bypass in conjunction with cardiopulmonary bypass with mild hypothermia. Methods and results - From March 2001 to June 2004, 72 patients underwent simultaneous coronary bypass and carotid endarterectomy. Their mean age was 68.9 years and there were 56 men and 16 women. The indication for carotid endarterectomy was a lumen diameter reduction of more than 75% and/or the presence of ulcerated/unstable plaque. Carotid endarterectomy was done during cardiopulmonary bypass under mild hypothermia, haemodilution, systemic heparinization and controlled haemodynamics under pulsatile perfusion for additional cerebral protection. The mean cardiopulmonary bypass time was 64.7 minutes and aortic cross-clamp time 32.4 minutes, and the mean number of grafts per patient was 2.7. Four patients had perioperative neurological complications (5.5%) and two had permanent deficits (2.7%). The procedure-related mortality was 3 (4.1%). Conclusions - We suggest that combining coronary revascularization and carotid endarterectomy and performing both under cardiopulmonary bypass is safe, offering acceptable morbidity and mortality rates.