Makale Koleksiyonu
Bu koleksiyon için kalıcı URI
Güncel Gönderiler
Öğe Myocardial protection in adult Bland-White-Garland syndrome(WILEY, 2020) Kunt, Atike Tekeli; Tumer, Naim Boran; Arsan, Sinan[Özet Yok]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 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.Öğe Effects of mesenchymal stem cell and amnion membrane transfer on prevention of pericardial adhesions(WALTER DE GRUYTER GMBH, 2020) Kabalci, Mehmet; Sahin, Mustafa; Pekcan, Zeynep; Zengin, Mehmet; Dogru, Mehmet Tolga; Kisa, UclerBackground: To investigate and compare the antiadhesive/antifibrotic effects of mesenchymal stem cells (MSC) and amnion membrane transfer (AMT) in a rat model. Material and methods: Three experimental and sham groups were formed using 30 Wistar-Albino rats. AMT and MSC were applied to the related groups. The control group was not treated. After 12 weeks follow-up, intracardiac blood and cardiac-pericardiac tissue samples were taken. The severity of adhesions and fibrosis were scored macroscopically and microscopically with Hematoxylin/ Eosin and Masson's trichrome staining. TNF-alpha, TGF-beta, IL-1, PDGF, FGF, VEGF and Caspase-3 levels were measured with the ELISA method. Results: Severe adhesions were observed in the AMT and control groups, but no adhesion was present in the MSC group. Pericardial thickness, increased vascularity, fibrosis, and collagen accumulation were similar between control and AMT groups, but were less in Sham and MSC groups. Between MSC and AMT groups, only Caspase-3 level was different, which is an apoptosis marker. Conclusion: The positive effects of MSC on adhesion, which we achieved in our study, suggest that it may prevent adhesion. AMT did not provide a positive effect. The correlation of Caspase-3 with postoperative adhesion/fibrosis should be examined in more detail.Öğe Mesenchymal stem cells have significant anti-infective effect on methicillin-resistant Staphylococcus epidermidis vascular graft infections(Turkish Joint Diseases Foundation, 2019) Canbeyli, Ibrahim Deniz; Kabalci, Mehmet; Cirpar, Meric; Tiryaki, Meral; Oktas, BirhanObjectives: This study aims to evaluate the effects of mesenchymal stem cell (MSC) implantation on vascular graft infections caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and compare with antibiotic treatment. Materials and methods: Healthy adult 56 Wistar rats (age, over 5 months: weighing. 300-350 g) were divided into eight groups. Group I was defined as the control group and group 2 was defined as the infected control group. Groups 3 and 4 were defined as Dacron grafted and MRSE infected groups. treated with tigecycline and MSCs. respectively. Groups 5 and 6 were performed polytetrafluoroethylene (PTFE) graft and infected with MRSE. These groups were also administered tigecycline and MSC treatment. respectively. Groups 7 and 8 were infected with MRSE without graft administration and were also performed tigecycline and MSC treatment. respectively. Grafts and soft tissue specimens were collected at 13 days postoperatively. Colony counts of pert-graft tissue were performed. All samples were evaluated by enzyme-linked immunosorbent assay (ELISA) for the markers that determine stem cell activity. Results: The overall success of the treatments was assessed by the number of rats with MRSE recurrence, regardless of graft used. The difference between the untreated group 2, tigecycline groups (3. 5 and 7) and MSCs groups (4.6 and 8) were statistically significant. Success of MSC and tigecycline treatments was similar in Dacron. PTFE, and non-grafted groups. There was a resistance of MRSE infection in Dacron groups to MSC and tigecycline treatments. This was considered to be indicative of the susceptibility of the Dacron grafts to infection. However, there was no significant difference between group 2 and Dacron groups in terms of bacterial colonization. ELISA results were significant in three cytokines. Conclusion: Mesenchymal stem cells can be considered as an alternative treatment option on its own or part of a combination therapy for control of vascular graft infections.Öğe Clinical Manifestations in Patients with Segmental Hypoplasia of Great Saphenous Vein(Kuwait Medical Assoc, 2017) Sipahi, Mesut; Bolat, Ali; Serin, Halil Ibrahim; Erkoc, Mustafa Fatih; Acikgoz, Burak; Kulah, BahadirObjectives: Segmental hypoplasia of the great saphenous vein (GSV) is a common condition which may cause chronic venous insufficiency. Despite the high incidence thereof, few studies have investigated GSV hypoplasia. We evaluated the presentations of patients with GSV segmental hypoplasia. Design: Prospective study Setting: Bozok Universty, School of Medicine, Yozgat, Turkey Subjects and methods: Demographic and clinical data, duplex ultrasound findings, length and location of the narrowing segments, and coexisting chronic venous insufficiency (CVI) and deep vein thrombosis (DVT), were retrospectively reviewed. Patients with segmental hypoplasia of the GSV were grouped according to the length and midpoint location of the narrow segment. The SPSS version 18.0 was used to conduct statistical tests. P-values < 0.05 were deemed to indicate statistical significance. Intervention: Ultrasound Main outcome measure: Hypoplastic GSV segments evaluation with ultrasonography Results: The study included 163 patients, 20% of whom were of an advanced age. We observed 257 extremities of the 163 patients. Varicose findings were observed in 62% of all patients. Comorbid CVI was significantly more common in the elderly than in the younger patients (P = 0.008). Skin changes occurred more frequently in male than in female (P = 0.016) and in elderly than in younger (P = 0.019) patients. The most common site of narrowing segments was below the knee. Conclusion: Segmental hypoplasia of the GSV commonly occurs in females. Male sex and advanced age are risk factors for skin changes, varicose findings, and DVT. DVT is more common in patients with hypoplastic segments longer than 5 cm.Öğe Mid-term results in the treatment of varicose veins with N-butyl cyanoacrylate(Sage Publications Inc, 2017) Eroglu, Erdinc; Yasim, Alptekin; Ari, Murat; Ekerbicer, Hasan; Kocarslan, Aydemir; Kabalci, Mehmet; Acipayam, MehmetAim To present mid-term results of patients with varicose veins treated with N-butyl cyanoacrylate (VariClose (R)), a nontumescent endovenous ablation technique. Patients and method Endovenous ablation was performed on 180 patients with saphenous vein incompetence between May and October 2014. One hundred sixty-eight subjects capable of being followed-up for 30 months were included. Patients' pre- and postoperative data were recorded. Results Procedures were performed on the great saphenous vein in 159 patients and on the small saphenous vein in nine patients. Saphenous vein diameters ranged between 5.5mm and 14mm. Full ablation was achieved in all patients following the procedure. No complications were encountered. Patients were monitored for 30 months. Ablation rates were 100% at the 3(rd) month, 98.3% at the 6(th) month, 96.6% at 1 year, and 94.1% at 30 months. Mean venous clinical severity score was 10.2 before procedures, decreasing to 3.9 at 3 months, 4.2 at 6 months, 2.9 at 12 months, and 2.7 at 30 months (p=0.000). Conclusion Due to its high success rate, absence of complications, no tumescent anesthesia requirement and high patient satisfaction, endovenous ablation with N-butyl cyanoacrylate is a good method. However, long-term follow-up results are now needed.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 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 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 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 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 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 Clinical and biomaterial evaluation of hyaluronan-based heparin-bonded extracorporeal circuits with reduced versus full systemic anticoagulation in reoperation for coronary revascularization(Lippincott Williams & Wilkins, 2009) Günaydın, Serdar; Farsak, Bora; Mccusker, Kevin; Vijay, Venkataramana; Sarı, Tamer; Onur, M. Ali; Zorlutuna, YamanObjective This prospective randomized study compares full and reduced heparinization on novel hyaluronan-based heparin-bonded circuits vs. uncoated controls under challenging clinical setting including biomaterial evaluation. Methods 100 patients undergoing reoperation for coronary artery bypass grafting were allocated into two equal groups (n = 50): Group one was treated with hyaluronan-based heparin bonded preconnected circuits (Vision HFOGBS, Gish, California, USA) and Group two with identical uncoated controls (Vision HFO, Gish, USA). In the study group, half of the patients (n = 25) received low-systemic heparin (125 IU/kg, ACT>250 s) or full dose like control group. Blood samples were collected after induction of anesthesia (T1) and heparin administration before cardiopulmonary bypass (CPB) (T2),15 min after initiation of CPB (T3), before cessation of CPB (T4),15 min after reversal with protamine (T5), and the first postoperative day at 08: 00 h (T6). Results Platelet counts were preserved significantly better at T5, T6 in hyaluronan groups (P<0.05 vs. control). Serum IL-2 levels were significantly lower at T4, T5 in both hyaluronan groups and C3a levels at T4 and T5 only in low-dose group (P<0.05). Troponin-T levels in coronary sinus blood demonstrated well preserved myocardium in hyaluronan groups. No significant differences in thrombin-antithrombin levels were observed between full and low-dose heparin groups at any time point. Amount of desorbed protein was 1.41 +/- 0.01 in full and 1.43 +/- 0.01 in low dose vs. 1.78 +/- 0.01 mg/dl in control (P<0.05). Conclusion Hyaluronan-based heparin-bonded circuits provided better clinical outcome and less inflammatory response compared with uncoated surfaces. Reduced systemic heparinization combined with hyaluronan-based heparin-bonded circuits is feasible and clinically well tolerated. J Cardiovasc Mad 10:135-142 (C) 2009 Italian Federation of Cardiology.Öğe Clinical evaluation of minimized extracorporeal circulation in high-risk coronary revascularization: impact on air handling, inflammation, hemodilution and myocardial function(Sage Publications Ltd, 2009) Günaydın, Serdar; Sarı Tamer; McCusker, Kevin; Schonrock, Uwe; Zorlutuna, YamanObjective: We examined intraoperative microembolic signals (GME), inflammatory response, hemolysis, perioperative regional cerebral oxygen saturation (rSO(2)), myocardial protection and desorbed protein amount on oxygenator fibers in high-risk patients undergoing coronary revascularization (CABG) with minimized and conventional cardiopulmonary bypass (CPB). Methods: Over a ten-month period, 40 Euroscore 6+ patients undergoing CABG were prospectively randomized to one of the two perfusion protocols (N=20): Group 1: minimized extracorporeal circuits (Mini-CPB) (ROCsafe MPC, Terumo, Ann Arbor, MI, USA) and Group 2: conventional extracorporeal circuits (CECC) (Capiox SX18, Terumo, USA). Serum creatinine kinase-MB (CKMB), free hemoglobin, interleukin-6 (IL-6) and C3a levels were measured. Blood samples were collected at T1: following induction of anesthesia; T2: thromboelastography control; T3: 15 min after commencement of CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal and T6: ICU. Results: Serum IL-6 levels were significantly lower in the Mini-CPB group at T4 and T5 and C3a levels were significantly less in the Mini-CPB group at T3, T4 and T5 vs. CECC (p < 0.01). CKMB levels in coronary sinus blood demonstrated well preserved myocardium in the Mini-CPB group. Percentage expression of neutrophil CD11b/CD18 levels were significantly lower in the Mini-CPB group at T4 and T5 (p < 0.05). There were no significant differences in air handling characteristics or free plasma hemoglobin levels in either circuit. rSO(2) measurements were significantly better at T3 and T4 in the Mini-CPB vs. CECC (p < 0.05) and always higher in the Mini-CPB during follow-up. Blood protein adsorption analysis of oxygenator membranes demonstrated a significantly increased amount of microalbumin on CECC fibers (p < 0.05). Conclusion: Mini-CPB provided a comfort and safety level similar to conventional control via satisfactory air handling, attenuated inflammatory response and hemodilution, with a better clinical outcome in patients undergoing high-risk CABG.Öğe Clinical efficacy of leukofiltration on cardiopulmonary bypass related inflammatory response: Fact or Foe?(Springer Basel Ag, 2009) Kılıç, Dilek; Günaydın, Serdar; Kısa, Üçler; Sari, Tamer; Deveci, Özcan; Zorlutuna, YamanThe powerful precept of preoperative risk assessment has been applied to compare the efficacy of leukofiltration techniques for high-risk cohorts with the documentation of broad indicators of systemic inflammation. Forty high risk patients were prospectively assigned to four perfusion protocols; the first group (n=10): Polyethyleneoxide (PEO) based heparin bonded extracorporeal circuits (ECC) + Continuous Leukocyte filtration; the second group (n=10): uncoated ECC + leukofiltration; the third group (n=10): PEO based heparin bonded ECC without leukofiltration; and control (n=10). Blood samples were obtained at the following intervals: Baseline (T1), on cardiopulmonary bypass (CPB) (T2), Cross clamp (T3), off CPB (T4), Intensive care unit-24 h (ICU24) (T5), ICU48 (T6). Tumor Necrosis Factor-alpha levels were significantly lower in Group 1 at T3, T4 (p < 0.05) vs. control. Procalcitonin levels were significantly lower in Group 1 at T5, T6 (p < 0.05) vs. control. Creatinine kinase-MB levels in coronary sinus blood demonstrated well preserved myocardium in filtered+coated (Group1) and coated groups (Group3) (p < 0.05). Matrix metallopeptidase- 9 and D-Dimer levels in filtered+coated group were significantly lower at T5 and T6 vs. control (p < 0.05). Leukocyte filtration on coated surfaces alleviated systemic inflammatory response with a better clinical outcome in high risk patients.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 STS blood conservation guidelines: The role of leukocyte filtration(Elsevier Science Inc, 2008) Gourlay, Terence; Olivencia-Yurvati, Albert H.; Gunaydin, Serdar…Öğe Influence of hematocrit and pump prime on cerebral oxygen saturation in on-pump coronary revascularization(Sage Publications Ltd, 2006) McCusker, Kevin; Chalafant, Anthony; Foe, Gordon de; Günaydın, Serdar; Vijay, VenkataramanaBackground: The couplings between cerebral oxygenation (rSO(2)), on-pump hematocrit and circuit prime are explored in this study. Methods: Thirty-eight consecutive patients undergoing coronary revascularization with cardiopulmonary bypass (CPB) were matched on preoperative hematocrit < 40% and > 40% (n = 16). Similarly, six blood prime patients were matched with six crystalloid prime patients. Hematocrit and rSO(2) levels were then compared on CPB. Results: The preoperative hematocrit > 40% group retained higher levels on pump run (p < 0.01) and significantly higher rSO(2) prior to CPB (64.8 +/- 9.6 versus 73.2 +/- 7.3), and on and off CPB (61.1 +/- 8.8 versus 67.4 +/- 6.4). Blood priming increased absolute rSO(2) (2.3 +/- 6.3 versus -10.9 +/- 5.9) and % rSO(2) (4.7 +/- 11.8 versus -14.2 +/- 7.4%) in the low hematocrit group. Conclusion: Blood primes are instrumental in high-risk and low preoperative hematocrit patients in preventing cerebral oxygen desaturation during initiation and maintenance of CPB.Öğe Comparison of polymethoxyethylacrylate-coated circuits with leukocyte filtration and reduced heparinization protocol on heparin-bonded circuits in different risk cohorts(Sage Publications Ltd, 2006) Günaydin, Serdar; McCusker, Kevin; Vijay, Venkataramana; İşbir, Selim; Sari, Tamer; Onur, Mehmet Ali; Zorlutuna, YamanObjectives: The relative benefits of strategic leukofiltration on polymer-coated and low-dose heparin protocol on heparin-coated circuits were studied across EuroSCORE patient risk strata for three different cohorts. Methods: In a prospective, randomized study, 270 patients undergoing coronary artery bypass grafting were allocated into three groups (n = 90): Group 1 - polymethoxyethylacrylate-coated circuits + leukocyte filters; Group 2 - polypeptide-based heparin-bonded circuits with reduced heparinization; and Group 3 - Control: uncoated circuits. Each group was further divided into three subgroups (n = 30), with respect to low- (EuroSCORE 0-2), medium- (3-5), and high- (6+) risk patients. Blood samples were collected at T1: following induction of anesthesia; T2: following heparin administration; T3: 15 min after CPB; T4: before cessation of CPB; T5: 15 min after protamine reversal; and T6: ICU. Results: In high-risk cohorts, leukocyte counts demonstrated significant differences at T4 and T5 in Group 1, and at T4 in Group 2. Platelet counts were preserved significantly better at T4 and T5 in both groups (p < 0.05 versus control). Serum IL-2 and C3a levels were significantly lower at T3, T4 and T5 in Group 1, and T4 and T5 in Group 2 (p < 0.05). Postoperative bleeding, respiratory support time and incidence of atrial fibrillation were lower in the study groups versus control. Cell counts on filter mesh and heparin-coated fibers/ circuits were significantly higher in the high-risk cohorts versus uncoated fibers. Phagocytic capacity increased on filter mesh, especially in high-risk specimens. SEM evaluation demonstrated better preserved coated circuits. Conclusion: Leukofiltration and coating reduced platelet adhesion, protein adsorption, atrial fibrillation and reduced heparinization acted via modulation of systemic inflammatory response in high-risk groups.
