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    Abdominal aortic aneurysm surgery: retroperitoneal or transperitoneal approach?
    (Minerva Medica, 2006) Çınar, B.; Göksel, Onur; Kut, S.; Çetemen, Şebnem; Şahin, S.; Eren, Emin Ergen
    Aim. Mortality and morbidity of abdominal aortic aneurysm surgery have decreased significantly in time and transperitoneal approach (TPA) still preserves its popularity although retroperitoneal approach (RPA) is known to cause lower incidence and shortened duration of ileus, shorter intensive care unit (ICU) and hospital stay, earlier oral intake and less patient discomfort or pain. Methods. One hundred and fifty patients that underwent abdominal aortic aneurysm repair at our Cardiovascular Surgery Center between January, 1990 and March, 2000 were reviewed and analyzed based on the elective/emergent nature of the surgery and the type of the incision as either TPA or RPA. Results. Significantly shorter mechanical ventilation (15.2±3.8 vs 10.1±2.3 hours) and nasogastric decompression periods (40.6±10.7 vs 9.1±2.2 hours), less need for intravenous fluid supplementation and shorter ICU stay (29.5±14.8 vs 18.6±1.9 hours) were observed with the retroperitoneal approach (P<0.001). Need for allogeneic blood transfusion was, similar (1.3±1.4 vs0.9±0.4, P>0.05). Analysis of mortality and morbidity revealed bleeding as the major cause of mortality for ruptured aneurysm. A similar comparison between TPA and RPA groups, however, revealed no significant difference (P>0.05). Conclusion. Retroperitoneal approach is a reliable technique causing less fluid-electrolyte imbalance with rapid restoration of gastrointestinal physiology. It causes less discomfort to patients with reduced need for analgesia. A shorter weaning period from mechanical ventilation is among the benefits for patients with co-morbid states.
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    Left ventricular giant pseudoaneurysm
    (Sage Journals, 2010) Çetemen, Şebnem; Soylu, Özer; Biçer, Mehmet; Aydoğan, Hakkı; Eren, Emin Ergen
    Left ventricular (LV) pseudoaneurysm is a rare complication of myocardial infarction. It may also occur as a complication of mitral valve surgery, chest trauma, and bacterial endocarditis. It forms when a cardiac rupture contains adherent pericardium or scar tissue and is typically located on the posterior or inferior LV wall. Pseudoaneurysms have a propensity to spontaneous rupture; hence, immediate surgical intervention is the treatment of choice for LV pseudoaneurysms diagnosed in the first months after myocardial infarction. The management of chronic LV pseudoaneurysms is still a subject of debate.
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    Mortality predictors in ST-elevated myocardial infarction patients undergoing coronary artery bypass grafting
    (Sage Journals, 2011) Kurç, Erol; Çetemen, Şebnem; Soylu, Özer; Aydoğan, Hakkı; Bayserke, Olgar; Yılmaz, Mürüvvet; Uyarel, Hüseyin; Ergelen, Mehmet; Orhan, Gökçen; Uğurlucan, Murat; Eren, Emin Ergen; Yekeler, İbrahim
    The use of coronary artery bypass grafting (CABG) in primary treatment of acute myocardial infarction is still debated. We evaluated the predictors of mortality in patients undergoing primary CABG for ST-elevated myocardial infarction (STEMI). Between January 2003 and January 2008, all patients referred to our institution with STEMI who did not qualify for primary angioplasty and required CABG were included in this study. Survivors and nonsurvivors were compared retrospectively in terms of demo-graphics, preoperative, intraoperative, and postoperative characteristics. Preoperatively confirmed cases of STEMI (n = 150) were included in the analysis. There were 114 survivors and 36 nonsurvivors. In-hospital mortality rate was 22%. In Cox regression analysis age, cardiogenic shock (Killip ?3), preoperative cardiac troponin levels, preoperative use of intra-aortic balloon counterpulsation (IABP), previous myocardial infarction, and percutaneous coronary intervention were independent predictors of in-hospital mortality. After multivariate analysis, factors predicting in-hospital mortality were age, preoperative cardiac troponin levels, and preoperative IABP. Age, preoperative cardiac troponin levels, and preoperative IABP use were predictive factors of in-hospital mortality in patients undergoing primary CABG for STEMI.