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Yayın The comparison of del nido cardioplegia and crystalloid-based blood cardioplegia in adult isolated coronary bypass surgery: A randomized controlled trial(Wolters Kluwer, 2022) Demir, Deniz; Balcı, A.B.; Kahraman, Nail; Sünbül, S.A.; Gücü, A.; Seker, I.B.; Badem, Serdar; Yüksel, Ahmet; Özyazıcıoğlu, A.F.; Göncü, M.T.; Demir, DenizBackground and Aim: In our study, patients who underwent isolated coronary artery bypass surgery (CABG) using Del Nido cardioplegia (DNC) and crystalloid-based cold blood cardioplegia (CBC) were compared. Subject and Methods: In this study, two groups of patients who underwent isolated CABG using DNC (n = 106) and CBC (n = 107) were prospectively randomized. Groups were compared in terms of many results such as troponin T, returning spontaneous rhythm, and cardioplegia volume. Results and Conclusions: Median troponin T levels of the DNC and CBC groups were compared for the 0th hour (baseline), 12th, 36th, and 60th hours. There was no statistical difference between groups in troponin T levels of the baseline 0th hour (18[33] vs. 22[27] pg/ml; P = 0.724). Troponin T levels at the 12th hour were less in the DNC group than the CBC group but no statistical difference between the groups (790[735] vs. 826[820] pg/ml; P = 0.068), respectively. Troponin T levels at 36th and 60th hours were higher in the CBC group compared to the DNC group, and a statistical difference was observed (580[546] vs. 650[550] pg/ml; P = 0.030) and (359[395] vs. 421[400] pg/ml; P = 0.020), respectively. After X-clamping, the spontaneous rhythm rate was statistically higher in the DNC group than the CBC group (72.60% vs. 37.40%; P < 0.001). There was no statistical difference between the groups in terms of postoperative arrhythmia, hospital stay, and mortality rates (P > 0.05). Based on data we acquired from the study, we think that DNC is at least as safe and effective as CBC in adult CABG cases.Yayın Popliteal artery injury due to blunt trauma: delayed diagnosis and treatment(Prusa Medical Publishing, 2015) Demir, Deniz; Abanoz, Mustafa; Çeviker, Kadir; Yontar, Yalçın; Erdolu, Burak; Kahraman, Nail; Demir, DenizDespite the appropriate treatment, the rate of amputation in popliteal artery injuries is still high in current practice. Hence, early diagnosis and treatment are extremely important in cases with such vascular injuries to save extremities. We present a 30-year-old male patient with popliteal artery injury, who had diagnosed 20 hours after internal fixation of the femoral fracture. He successfully underwent arterial repair.Yayın A rare complication of double prosthetic valve endocarditis; reconstructive surgical treatment of mitral-aortic intervalvular fibrosa pseudoaneurysm and left atrial fistula(Wiley Online Library, 2022) Kahraman, Nail; Topal, Dursun; Altunal, Ayşe Merve; Tiryakioğlu, Selma Kenar; Taner, Temmuz; Demir, Deniz; Çetin, Mustafa Levent; Demir, DenizMitral aortic intervalvular fibrosa or aorto-mitral curtain is a fibrous avascular skeletal structure located between the anterior leaflet of the mitral valve and the non-coronary and left coronary cusps of the aortic valve. Mitral and aortic valve endocarditis are rarely accompanied by mitral aortic intervalvular fibrosa pseudoaneurysm and left atrial fistula of the aorta. Pseudoaneurysm of mitral aortic intervalvular fibrosa is a fatal complication that can occur after valvular surgery, valvular endocarditis, or blunt trauma. In this article, reconstructive surgical management with the Commando technique of a case who developed mitral-aortic intervalvular fibrosa pseudoaneurysm to left atrial fistula after aortic and mitral prosthetic valve endocarditis is described. The important feature of this article is that it is a first in the literature as it is accompanied by persistent left superior vena cava.Yayın Short-term and midterm treatment results in stanford type-b acute dissection patients(Hatay Mustafa Kemal Üniversitesi, 2019) Demir, Deniz; Kahraman, Nail; Demir, DenizAmaç: Stanford Tip B akut aortik diseksiyonu (Tip B-AAD) kardiyovasküler hastalıklar içinde yüksek ölüm oranına sahiptir ve tedavisinin karmaşıklığı da önemli bir sorundur. Hastalığın tedavisinde diseksiyonun süresi, komplike ya da unkomplike olması belirleyici rol oynamaktadır. Bu çalışmada Tip B akut aortik diseksiyon sebebi ile takip ve tedavi ettiğimiz hastaların sonuçlarını değerlendirdik. Gereç ve Yöntem: Çalışma tek merkezli ve retrospektif olarak yapılmıştır. Hastaların tedavi stratejisi diseksiyonun akut, kronik olması ve komplike ya da unkomplike olmasına göre belirlendi. Hastalar medikal, TEVAR ya da açık cerrahiyle tedavi ve takip edildiler. Hastalara ait mortalite ve morbidite sebebleri kaydedildi. Bulgular: Toplamda 23 hasta Tip B akut aortik diseksiyonu sebebi ile tedavi edildi. Hastaların yaş ortalaması 58.21±14.17 yıl idi. Takip edilen hastaların büyük çoğunluğu medikal tedavi 16 (%69.5) ile takip edildi. TEVAR tedavisi ile takip edilen hastalar ise ikinci sıklıktaydı. TEVAR hastaları 5 (%21.7) oranında idi. İki hasta ise açık cerrahi ile tedavi edildi. Otuz günlük sağkalım 20 hastada (%86,9) oranında gözlendi. Toplam mortalite ise 3 hastada (%13) oranında görülmüştür. Tartışma: Tip B-AAD ile başvuran hastaların yaklaşık %25’i hastaneye malperfüzyon sendromu veya hemodinamik instabilite ile başvurmaktadırlar. Organ malperfüzyonu ve hemodinamik instabilite bu hastaların ölümlerinde en önemli sebeblerdir. Bundan dolayı hastalığın erken tanısı ve optimal tedavisi hayat kurtarıcı olmaktadır. Tip B-AAD sebebi ile tedavi edilen hastalar unkomplike tipte ise konvansiyonel medikal tedavi ön plandadır. Komplike hastalarda ise TEVAR tedavisi ya da açık cerrahi önerilmektedir. Bizim 23 hastadan oluşan hasta grubumuzdaki toplam mortalite oranımız 3 (%13) hastada oranında görülmüştür. Böbrek yetmezliği ve pleji oranları ise %4.3 oranında saptandı. TEVAR hasta grubunda mortaliteye rastlanmadı. Sonuç: Sonuç olarak Tip B-AAD hastalarının tedavisinde unkomplike tipteki hastalar için öncelikle konvansiyonel medikal tedaviyi öneriyoruz. Komplike tipteki hastalarda TEVAR tedavisini öneriyoruz. TEVAR için gerekli ekipman temin edilemediği acil durumlarda ise açık cerrahiyi öneriyoruz.Yayın Systemic immune-inflammation index for predicting poor outcome after carotid endarterectomy: A novel hematological marker(SAGE Journals, 2022) Yüksel, Ahmet; Velioğlu, Yusuf; Korkmaz, Ufuk Turan Kürşat; Deşer, Serkan Burç; Topal, Dursun; Badem, Serdar; Taner, Temmuz; Uçaroğlu, Erhan Renan; Kahraman, Nail; Demir, Deniz; Demir, DenizObjective To investigate the predictive role of systemic immune-inflammation index (SII) on postoperative poor outcome in patients undergoing carotid endarterectomy (CEA). Methods A total of 347 patients undergoing elective isolated CEA between March 2010 and April 2022 were included in this multicenter retrospective observational cohort and risk-prediction study and were divided into two groups as poor outcome group (n = 23) and favorable outcome group (n = 324). Poor outcome was defined as the presence of at least one of the complications within 30 days of surgery including stroke, myocardial infarction, and death. The patients' baseline clinical characteristics, comorbidities, and hematological indices were derived from the complete blood count (CBC) analysis, and perioperative data, outcomes, and complications were screened, recorded, and then compared between the groups. Multivariate logistic regression and receiver-operating characteristic (ROC) curve analyses were conducted following univariate analyses to detect the independent predictors of poor outcome as well as the cutoff values with sensitivity and specificity rates. Results A total of 23 patients out of 347 (6.6%) manifested poor outcome; and stroke, myocardial infarction, and death occurred in 13, 3, and 7 cases, respectively. There were no significant differences between the groups in terms of basic clinical characteristics, comorbidities, and perioperative data, except for lengths of intensive care unit and hospital stays. Although the median values of PLT, PLR, NLR, and SII of the poor outcome group were found to be significantly higher than the favorable outcome group in univariate analysis, only SII was detected to be a significant and independent predictor of poor outcome in multivariate logistic regression analysis (OR = 1.0008; 95% CI: 1.0004–1.0012; p = 0.002). ROC curve analysis revealed that SII of 1356 × 103/mm3 constituted the cutoff value for predicting poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746; 95% CI: 0.64–0.851). Conclusions Our study revealed for the first time in the literature that SII significantly predicted poor outcome after CEA.
