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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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    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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    Reperfusion strategy after regional ischaemia: Simulation of emergency revascularization and effects of integrated cardioplegia on myocardial resuscitation
    (SAGE PUBLICATIONS LTD, 2004) Us, MH; Ogus, NT; Yildirim, T; Ogus, H; Ozkan, S; Ozturk, OY; Isik, O
    We induced ischaemia in the left anterior descending artery of 16 dogs while the heart was beating, followed by cardiopulmonary bypass (CPB), aortic cross clamping and blood cardioplegia. Half of the dogs received integrated blood cardioplegia and sudden uncontrolled reperfusion (group A) while the others received the same cardioplegia followed by pressure-controlled tepid initial reperfusion (group B). The effects on myocardial cell metabolism, oxidative stress and ultrastructure were recorded. The recovery period was significantly longer and cardiac output levels after CPB significantly lower in group A compared with group B. Group A showed a failure to uptake and utilize oxygen during the recovery period and significant lipid peroxidation. Marked tissue oedema was seen in group A but mitochondrial and organelle integrity was almost normal in both groups. We conclude that integrated cardioplegia could partially resuscitate the myocardium in this model, and pressure controlled reperfusion during the first 2 min is needed as an adjunct procedure.
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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.