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Öğe Cardiopulmonary bypass technologies(Woodhead Publ Ltd, 2010) Gunaydin, SerdarCardiopulmonary bypass (CPB) has revolutionized our ability to operate on the heart, great vessels, and aorta in addition to providing means of short-term support for reversible causes of cardiac and/or respiratory failure. This chapter summarizes current concepts of CPB with particular emphasis on the biomaterial developments currently taking place. Although routine application of CPB is shrinking under pressure from less invasive techniques, this may represent an opportunity to deliver a more highly evolved perfusion to the core of very sick and complex patients who may not be suitable candidates for alternative therapy. These patients will benefit from the application of new technologies currently under development, such as smaller perfusion circuits, filtration techniques, improved biomaterial surfaces, smart membranes, and biosensor technology, all aimed at making clinical perfusion a safer and more predictable procedure for the patient.Öğe Clinical and biomaterial evaluation of a new condensed dual-function extracorporeal circuit in reoperation for coronary artery bypass surgery(Sage Publications Ltd, 2009) Gunaydin, Serdar; McCusker, Kevin; Vijay, VenkataramanaPurpose: This prospective, randomized study compared the clinical performance of three types of circuits: a newly introduced, fully-coated, interchangeable open-closed circuit with a dual configuration (hard shell with a bypass shunt), reduced length, and reduced prime of less than 800 cc (CondEC); a completely coated circuit (EC); and a similar uncoated, open circuit with standard length and prime (CONT). Methods: 75 patients undergoing reoperation for coronary revascularization were randomly allocated into three groups (N=25): Group 1: CondEC with shortened tubing, components and an open-closed configuration of low priming volume with a centrifugal pump and a shunt which bypassed the reservoir for closed configuration; Group 2: EC with a roller pump and hard-shell reservoir; Group 3: CONT. Blood samples for CBC, inflammatory mediators [Interleukin-2 (IL-2), Complement-3a (C3a)] and flow cytometry (CD11b/CD18) were collected after induction (T1) and heparin administration (T2), 15 min after cardiopulmonary bypass (CPB) (T3), before cessation of CPB (T4), 15 min after reversal (T5), and the first postoperative day (T6). Results: Leukocyte counts demonstrated significant increases at T4, T5 in CONT but remained stable in EC and CondEC (p<0.05). Platelets were preserved better at T4, T5 in both EC and CondEC study groups (p<0.05). IL-2 and C3a levels were significantly lower at T3, T4, T5 in CondEC and T4, T5 in EC (p<0.05). Blood protein adsorption analysis demonstrated increased amount of microalbumin on CONT fibers (p<0.05). Conclusions: The CondEC is a flexible, dual-function, open/closed configuration system that was easy to use, safe and achieved better biocompatibility when compared to coated and uncoated conventional circuits. (Int J Artif Organs 2009; 32: 802-10)Öğe Clinical evaluation of leukocyte filtration as an alternative anti-inflammatory strategy to aprotinin in high-risk patients undergoing coronary revascularization(Springer, 2012) Farsak, Bora; Gunaydin, Serdar; Yildiz, Ulku; Sari, Tamer; Zorlutuna, YamanPurpose The use of aprotinin in cardiac surgery is associated with overriding safety concerns. Therefore, there is increased research on alternatives. This study investigated the relative benefits of strategic leukofiltration on polymer-coated extracorporeal circuits (ECC), aprotinin, and combined therapy in high-risk patients. Methods Eight hundred and seventy-five patients (Euro-SCORE 6+) undergoing coronary revascularization over a 4-year period were prospectively randomized to one of four perfusion protocols: Group 1: polymethoxyethylacrylate (PMEA)-coated circuits + leukocyte filters (n = 214); Group 2: uncoated ECC + full Hammersmith aprotinin (n = 212); Group 3: PMEA-coated ECC + leukofilters + full Hammersmith aprotinin (n = 199); and Group 4: control no treatment (n = 250). Blood samples were collected at times T1: following the induction of anesthesia; T2: following heparin administration; T3: 15 min after cardiopulmonary bypass (CPB); T4: before cessation of CPB; T5: 15 min after protamine reversal; and T6: in the intensive care unit. Results The serum interleukin-2 levels were significantly lower at T3, T4, and T5 in all study groups. C3a levels were significantly lower at T3. Creatine kinase MB and lactate levels demonstrated well-preserved myocardia in both leukofiltration groups (P < 0.05). Neutrophil CD11b/CD18 levels were significantly lower for all study groups. Postoperative bleeding and respiratory support time were lower in all study groups. Conclusion Leukofiltration on coated circuits significantly reduced bleeding and inflammatory response related to CPB with no adverse effects, and may be a possible alternative to pharmacological intervention.Öğe Clinical performance and biocompatibility of hyaluronan-based heparin-bonded extracorporeal circuits in different risk cohorts(Oxford Univ Press, 2010) Gunaydin, Serdar; McCusker, Kevin; Sari, Tamer; Onur, Mehmet Ali; Zorlutuna, YamanThis prospective randomized study compares novel hyaluronan-based heparin-bonded circuits vs. uncoated controls across EuroSCORE patient risk strata including biomaterial evaluation. Over a two-year period, 90 patients undergoing coronary artery bypass grafting were prospectively randomized to one of the two perfusion protocols: Group 1 was treated with hyaluronan-based heparin-bonded preconnected circuits (Vision HFO-GBS (TM), Gish, CA, USA) and Group 2 with identical uncoated controls. Each group was composed of three subgroups (n = 15) with respect to preoperative evaluation of low (EuroSCORE 0-2), medium (3-5) and high (6+) risk patients. Blood samples were collected after induction (T1) and heparinization (T2), 15 min after cardiopulmonary bypass start (T3), before cessation of CPB (T4), 15 min after reversal (T5), and the first postoperative day (T6). In high-risk patients, platelet counts demonstrated significant preservation at T4, T5 and leukocyte counts were lower at T5 in hyaluronan group (P <= 0.05 vs. control). C3a (ng.ml(-1)) levels were significantly lower at T3 (0.2 +/- 0.04 vs. 0.31 +/- 0.05), T4 (0.25 +/- 0.04 vs. 0.51 +/- 0.05), T5 (0.38 +/- 0.04 vs. 0.56 +/- 0.05) and interleukin-6 (pg.ml(-1)) at T4 (91 +/- 18 vs. 124 +/- 20), T5 (110 +/- 20 vs. 220 +/- 25) in coated group vs. control (P <= 0.05). Protein desorption (microalbumin) on fibers (mg.mm(-3)) was less in hyaluronan vs. control groups (P <= 0.05). Hyaluronan coating reduced platelet adhesion and cell adsorption, and modulated inflammatory response in high-risk patients. (c) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.Öğe Comparison between intravenous and thoracic epidural analgesia in single coronary artery bypass graft surgery(Tubitak Scientific & Technical Research Council Turkey, 2012) Salman, Nevriye; Serter, Fatih Tanzer; Ucar, Halil Ibrahim; Gunaydin, Serdar; Yorgancioglu, Ali CemAim: To compare thoracic epidural analgesia with intravenous analgesia in patients who underwent coronary artery bypass grafting surgery. Materials and methods: This retrospective study included 40 patients who had received elective single artery bypass surgery. After general anesthesia, one group was given patient-controlled thoracic epidural analgesia and the other group was given patient-controlled intravenous meperidine analgesia. Patient assessments were performed during the postoperative period and included the duration of hospital stay, pain and sedation scores, ambulation score, atrial fibrillation incidence, and organ morbidities. Results: No differences were detected between the groups in the demographic or intraoperative data. However, a statistically significant difference was detected in favor of thoracic epidural analgesia for the duration of extubation and hospital stay, pain control, sedation grade, mobilization, and quality of recovery scores. Conclusion: After single coronary artery surgery, thoracic epidural analgesia was more effective than intravenous analgesia; it also enabled earlier tracheal extubation and a shorter hospitalization period.Öğe Isolation, culturing and characterization of rat adipose tissue-derived mesenchymal stem cells: a simple technique(Tubitak Scientific & Technical Research Council Turkey, 2012) Niyaz, Mehmet; Gurpinar, Ozer Aylin; Gunaydin, Serdar; Onur, Mehmet AliIn this study, our aim was to develop a new simple technique for isolation of mesenchymal stem cells from adipose tissue. For this purpose, mesenchymal stem cells were isolated from rat adipose tissue by using the primary explant culture technique. When the cells became confluent, they were passaged 4 times by using the standard trypsinization method with trypsin/EDTA solution. Cells at second passage were characterized by using immunofluorescence staining against CD13 and CD29 markers. The results showed that these cultured cells were positive for CD13 and CD29 markers. Flow cytometry analysis was also done against CD29, CD90, CD54, MHC Class I, CD45, CD 106, and MHC Class II for characterization of mesenchymal stem cells. The results of flow cytometry analysis showed that these cells were mesenchymal stem cells. Half of the cells were cryopreserved at all passages for future applications. It is thought that these mesenchymal stem cells can be used in therapy of cardiovascular diseases as an alternative technique in the near future.Öğe Novel Ultrafiltration Technique for Blood Conservation in Cardiac Operations(Elsevier Science Inc, 2013) Gunaydin, Serdar; Gourlay, TerencePurpose. The performance characteristics and clinical outcome of a novel hemoconcentrator, the HemoSep (Brightwake, Nottingham, United Kingdom), for reusing salvaged blood postoperatively were evaluated. Description. HemoSep concentrates blood by removing the fluid component from a pooled volume of blood salvaged at the end of the operation from the heart-lung machine. During a 6-month period, 102 patients were prospectively randomized into two groups. In group 1 (n = 52), salvaged blood in the venous reservoir after the cessation of cardiopulmonary bypass was reused by the HemoSep device and the processed blood was retransfused to the patients. In group 2 (n = 50), the control group, the operation proceeded using conventional method without using the hemoconcentrator. Evaluation. The mean amount of processed blood was 775 +/- 125 mL. The efficacy of the HemoSep device was confirmed by the percentage concentration of the hematocrit at 15 and 40 minutes. Serum albumin and factor VII levels were concentrated more than threefold at 40 minutes vs baseline measurements. Patients who received processed blood had significantly less need for an allogeneic transfusion. Conclusions. The HemoSep device functions as designed and without technical failures, offering a complementary technique in blood management during cardiac operations. (C) 2013 by The Society of Thoracic SurgeonsÖğe Perioperative blood conservation strategies in pediatric patients undergoing open-heart surgery: impact of non-autologous blood transfusion and surface-coated extracorporeal circuits(Sage Publications Ltd, 2011) Gunaydin, Serdar; McCusker, Kevin; Vijay, VenkatramanaBackground: The aim of this study was to explore the relative clinical and biomaterial effects of blood transfusions (Tx) and novel low-prime, surface-coated circuitry on perioperative outcome in a pediatric population undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: Over a 12-month period, 80 patients weighing > 10 kg undergoing ventricular septal defect (VSD) repair with CPB were prospectively randomized into two groups according to the type of CBP circuit used, then each randomized group was enrolled into two groups again, according to the need for transfusion (N=20): Group 1-Tx-free procedures on low-prime, surface-coated extracorporeal circuitry (FX05, Terumo); Group 2-procedures requiring Tx on coated circuitry; Group 3-Tx-free procedures with standard uncoated circuitry (D902, Sorin); Group 4 (Control)-procedures requiring Tx on uncoated circuitry. Blood samples were collected at baseline (T1), at the end of the CPB (T2) and 24 h (T3) postoperatively. rSO(2) desaturation risk score > 6000 (Invos, Somanetics) was calculated by multiplying rSO(2) < 50% by time. Results: IL-6 levels (pg/ml) were significantly lower in Groups 1 and 3 versus control at T2 (13 +/- 4; 17 +/- 5 versus 33 +/- 8; p < 0.05). CD11b/CD18 levels (%) were significantly lower in Group 1 (12 +/- 4) versus control (25 +/- 8) at T2 (p < 0.05). Respiratory support time (h) was significantly less in Group 1 (11.4 +/- 6) versus control (19.8 +/- 7) (p < 0.05). rSO(2) desaturation risk > 6000 (%) was 15.7 +/- 9 in Group 1 and 26.8 +/- 11 in control (p < 0.05). Conclusion: Allogenic Tx amplifies the CPB-related inflammatory response. It is feasible to do congenital procedures safely without Tx for patients weighing > 10 kg by using combined blood management strategies.Öğe Preoperative Vitamin D Level is Associated with Postoperative Delirium After Cardiac Surgery in Patients Over 65 Years of Age(FORUM MULTIMEDIA PUBLISHING, LLC, 2020) Tumer, Naim Boran; Kunt, Atike Tekeli; Gunaydin, Serdar; Ozisik, KanatIntroduction: Delirium after cardiac surgery is a devastating and important complication. Delirium is defined as "disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)." In this study, we analyzed the association of preoperative vitamin D levels and postoperative delirium after cardiac surgery in patients over 65 years. Materials and methods: We retrospectively reviewed the data of 212 adult patients above 65 years of age who underwent isolated coronary artery bypass graft surgery from January 2016 to January 2018. The mean age for Group I was 69.7 +/- 7.4 and Group II was 70.6 +/- 4.8 years. There were 112 female patients in Group I and 46 female patients in Group II. The patient population was divided into 2 groups based on preoperative serum vitamin D (25-hydroxyvitamin D [25-OHD]) levels (normal range of 25-75nmol/L). Group I included patients with preoperative serum 25-OHD level<25nmol/L. Group II included patients with preoperative serum 25-OHD level >= 25nmol/L. Results: The incidence of delirium in this study was 30.2%. In this study, 138 patients (65.1%) had preoperative serum 25-OHD levels <25 nmol/L, and 74 patients (34.9%) had preoperative serum 25-OHD levels >= 25 nmol/L. Preoperative serum 25-OHD levels were associated with postoperative delirium after coronary artery bypass graft surgery. Our retrospective study illustrated that a lower preoperative serum level of 25-OHD was associated with postoperative delirium. Our results showed that 65.1% of patients had preoperative serum 25-OHD levels <25 nmol/L, and this was associated with postoperative delirium. Conclusion: Vitamin D deficiency exacerbates delirium after coronary artery bypass surgery with cardiopulmonary bypass. Whether the effects of vitamin D deficiency during this event represent separate or interrelated activities with cardiopulmonary bypass is an important question to address and prospective randomized studies are necessary to confirm these results.Öğe STS blood conservation guidelines: The role of leukocyte filtration(Elsevier Science Inc, 2008) Gourlay, Terence; Olivencia-Yurvati, Albert H.; Gunaydin, Serdar…Öğe Subclinical Hypothyroidism Increases the Requirement of Renal Replacement Therapy After Cardiac Surgery(FORUM MULTIMEDIA PUBLISHING, LLC, 2020) Tumer, Naim Boran; Kunt, Atike Tekeli; Keles, Hatice; Ozisik, Kanat; Gunaydin, SerdarBackground: Subclinical or biochemically diagnosed hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels. Thyroid hormones play a major role in the normal function of the heart and vascular physiology. Atherosclerosis, increased systemic vascular resistance, and decreased arterial compliance are common pathophysiological changes that may occur in hypothyroidism. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, diabetes mellitus (DM), preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of SCH on AM and the requirement of renal replacement therapy (RRT) after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 336 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL) from January 2017 to January 2019. The patients were divided into two groups either having the diagnosis of SCH (Group I, N = 47) or not (Group II, N = 289). SCH was diagnosed based on preoperative serum TSH and FT4 levels. Kidney injury was interpreted, according to RIFLE classification. The effect of SCH on AM and the need for RRT after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Subclinical hypothyroidism was diagnosed in 14% of all patients. Postoperative AKI occurred in 15 patients (31.9%) in Group I, whereas there were 42 patients (14.5%) in Group II. On logistic regression analysis, the presence of SCH was shown to be associated with an increased incidence of postoperative AKI (OR, 0.363; 95% CI, 0.181-0.727; P = .004). RRT was used in 2.97% of patients (seven patients in Group I and three patients in Group II, P < .001). The 30-day mortality was 2.1%. Conclusion: The presence of SCH seems to be associated with an increased incidence of AKI and increased requirement for RRT after cardiac surgery.
