Zihni Mert Duman

Elazığ Eğitim ve Araştırma Hastanesi

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Muhammed Bayram

Burdur Mehmet Akif Ersoy Üniversitesi

Barış Timur

Dr. Siyami Ersek Göğüs Kalp Ve Damar Cerrahisi Eğitim Ve Araştırma Hastanesi

Ersin Kadiroğulları

Burdur Mehmet Akif Ersoy Üniversitesi

Emre Yaşar

Education Training And Research

Timuçin Aksu

Burdur Mehmet Akif Ersoy Üniversitesi

Mustafa Can Kaplan

Education Training And Research

ÜA

Ünal Aydın

Burdur Mehmet Akif Ersoy Üniversitesi

Burak Onan

Burdur Mehmet Akif Ersoy Üniversitesi

Zinar Apaydın

Ministry of Health

AÜ

Aydın Ünal

Burdur Mehmet Akif Ersoy Üniversitesi

Cooperative Institutions

Burdur Mehmet Akif Ersoy Üniversitesi

Sağlık Bilimleri Üniversitesi

Dr. Siyami Ersek Göğüs Kalp Ve Damar Cerrahisi Eğitim Ve Araştırma Hastanesi

University of Health Science

Sivas State Hospital

Istanbul University-Cerrahpaşa

Istanbul University

Ministry of Health

University of Health Sciences

Education Training And Research

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Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery

Figshare (2023)

Zihni Mert Duman Barış Timur

ABSTRACT Introduction: The heart and liver are two organs that are closely related. The Albumin-Bilirubin (ALBI) score is a developed scoring system for assessing liver function. The aims of this study were to examine the correlation between preoperative ALBI score and pulmonary artery pressure and to investigate its ability to predict heart valve surgery mortality outcomes. Methods: The data of 872 patients who underwent isolated and combined heart valve surgery from 2014 to 2021 were retrospectively screened. In the preoperative period, 152 patients with laboratory tests including albumin and total bilirubin were found and analyzed retrospectively. Thirteen of these patients were excluded from the study. The remaining 139 patients were included in the analysis. Baseline demographic data, echocardiography data, performance status, laboratory data, operative data, and postoperative status were collected. The optimal cutoff value of preoperative ALBI score was calculated. Results: The cutoff for ALBI scores was calculated as -2.44 to predict in-hospital mortality (sensitivity = 75.0%, specificity = 70%). Based on the cutoff value, 90 patients had a low ALBI score (≤ -2.44, 64.7%) and 49 patients had a high ALBI score (> -2.44, 35.3%). High ALBI score was associated with an increased incidence of acute kidney injury and in-hospital mortality, and a positive correlation was found between ALBI score and pulmonary artery pressure. Conclusion: In patients with valvular surgery, high ALBI score was an independent prognostic factor of in-hospital mortality and acute kidney injury. It is easily measurable and a cost-effective way to predict mortality.

10.6084/m9.figshare.22548309

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Central vs. Peripheral Cannulation During Reoperations: A Propensity Score Matching Analysis

Brazilian Journal of Cardiovascular Surgery (2023)

Zihni Mert Duman Ersin Kadiroğulları Mustafa Can Kaplan Barış Timur Aylin Demirel Başgöze

The aim of this study is to compare the postoperative outcomes and early mortality of peripheral and central cannulation techniques in cardiac reoperations using propensity score matching analysis.In this retrospective cohort, patients who underwent cardiac reoperations with median resternotomy were analyzed in terms of propensity score matching. Between November 2010 and September 2020, 257 patients underwent cardiac reoperations via central (Group 1) or peripheral (Group 2) cannulation. A 1:1 propensity score matching was performed to balance the influence of potential confounding factors to compare postoperative data and mortality rate.There were no significant differences when comparing the matched groups regarding early mortality (P=0.51), major cardiac injury (P=0.99), prolonged ventilation (P=0.16), and postoperative stroke (P=0.99). The development of acute renal failure (P=0.02) was statistically less frequent in Group 1.Performing cardiopulmonary bypass via peripheral cannulation increases acute renal failure in cardiac reoperations. In contrast, peripheral or central cannulation have similar early mortality rate in cardiac reoperations.

10.21470/1678-9741-2022-0463

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Thoracoabdominal aortic aneurysm repair: A Single center experience

Turkish Journal of Vascular Surgery (2022)

Ünal Aydın Zihni Mert Duman Emre Yaşar Muhammed Bayram Sefa Eltutan

Aim: The gold standard repair of thoracoabdominal aortic aneurysm (TAAA) is still open surgery. However, few cardiovascular centers are experienced in TAAA repair. The aim of this study was to examine the methods and four-year outcomes of the open TAAA repair program initiated by a single surgical team. Material and Methods: In this retrospective cohort, patients who were operated for TAAA between August 2018 and March 2022 were collected. Patients treated with the endovascular approach were excluded. After exclusion, 19 patients were included in our analysis. As postoperative outcomes, in-hospital mortality, spinal cord deficit, major neurologic complications, need for dialysis, and visceral ischemia were collected. Results: Crawford extent II TAAA repair was performed in 10 (52.6%) patients, Crawford extent III in 5 (26.3%) patients, and Crawford extent IV in 4 (21.1%) patients. In hospital mortality occurred in 6 (31.6%) patients. The causes of mortality were perioperative myocardial infarction in 2 (10.5%) patients, visceral ischemia in 1 (5.3%) patient, multisystem organ failure in 3 (15.8%) patients. The highest mortality rate (50.0%) occurred in Crawford extent II repair. Spinal cord deficit developed in 2 (10.5%) patients. Conclusion: Thoracoabdominal aortic aneurysm surgery is associated with high mortality rates. Open thoracoabdominal aortic aneurysm repair programs in tertiary vascular centers should be supported, to improve the surgical results of thoracoabdominal aortic aneurysm repair.

Thoracic aortic aneurysm

Paraplegia

10.9739/tjvs.2022.09.08

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Impact of Bileaflet Mechanical Mitral Valve Orientation on Pannus Overgrowth

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery (2023)

Zihni Mert Duman Zinar Apaydın İsa Can Mustafa Can Kaplan Abdül Kerim Buğra

Pannus overgrowth is a chronic inflammatory process that can cause valve dysfunction and threaten the durability of prosthetic valves. Bileaflet mechanical mitral valve can be implanted in either an anatomical (parallel to the anatomical axis) or nonanatomical (perpendicular or oblique to the anatomical axis) orientation. The effect of the rotational orientation of the bileaflet mechanical mitral valve on excessive pannus enlargement is unknown. The present study compared the effect of bileaflet mechanical mitral valve orientation on pannus overgrowth.The study included patients who underwent bileaflet mechanical mitral valve replacement for rheumatic mitral valve stenosis. The pannus formation was confirmed by reexamining all transesophageal echocardiography images in the picture archiving and communication systems between May 2017 and April 2021. The primary aim of this study was the development of pannus overgrowth. Patients were divided into 2 groups based on their implantation orientation of the bileaflet mechanical mitral valve.Pannus overgrowth was found in 26 patients (56.5%) in the anatomical orientation group and 71 patients (74.7%) in the nonanatomical orientation group (P = 0.03). Anatomical orientation reduced the development of pannus overgrowth (odds ratio [OR] = 0.39, P = 0.04), and double left heart valve replacement increased the development of pannus overgrowth (OR = 2.73, P = 0.04).Pannus overgrowth was less common in bileaflet mechanical mitral valves implanted in the anatomical orientation.

Pannus

Mitral valve replacement

10.1177/15569845231199100

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Minimally invasive versus conventional mitral valve surgery: A propensity score matching analysis

Turkish Journal of Thoracic and Cardiovascular Surgery (2023)

Emre Yaşar Zihni Mert Duman Muhammed Bayram Mete Gürsoy Ersin Kadiroğulları

Background: This study aimed to compare the outcomes of minimally invasive mitral valve surgery and conventional surgery in terms of mortality and postoperative complications. Methods: A retrospective analysis was conducted on consecutive minimally invasive and conventional mitral valve surgeries performed between January 2019 and December 2022. Patients undergoing concomitant procedures were excluded from the study, and 293 patients (149 females, 144 males; mean age: 53.8±12.9 years; range, 18 to 82 years) were included in the study. Of these patients, 96 underwent minimally invasive surgery (MI group), and 197 underwent mitral valve surgery via conventional sternotomy (CS group). Propensity score matching was utilized to minimize the biases and confounding factors. After propensity score matching, 55 patients were included in each group. Results: There was no statistically significant difference in terms of mortality between the propensity score-matched groups (p=0.315), and no statistically significant difference in postoperative complications was observed between the groups. However, it was found that postoperative new-onset atrial fibrillation was lower in the minimally invasive group (p=0.022). Conclusion: This study demonstrates that minimally invasive mitral valve surgery is a safe alternative with similar mortality and postoperative complication rates compared to conventional surgery. Additionally, the study suggests an association between minimally invasive surgery and postoperative new onset atrial fibrillation.

Concomitant

10.5606/tgkdc.dergisi.2023.25404

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The role of the angle of the ascending aortic curvature on the development of type A aortic dissection: ascending aortic angulation and dissection

Interactive Cardiovascular and Thoracic Surgery (2019)

Safa Göde Okan Akıncı Cigdem Tel Ustunısık Onur Şen Ersin Kadiroğulları

Type A aortic dissection (TAD), which consists of an intimal tear in the aorta, necessitates emergency surgery. Various risk factors related to aortic dissection have been defined in the literature. According to our hypothesis, a narrower angle of ascending aortic curvature (AAAC) may be an additional risk factor in relation to aortic dissection due to the increased force applied to the aortic wall.Patients undergoing ascending aortic surgery due to an ascending aortic aneurysm (AsAA) (n = 105) and patients undergoing such surgery because of the occurrence of TAD (n = 101) were enrolled in this study. The AAAC was measured using Cobb's method; the measurements were made on all patients by just 1 cardiovascular radiologist using 3-dimensional computerized tomographic imaging. This measurement was made indirectly by using the aortic valve and brachiocephalic artery to avoid obtaining misleading data as a result of distortions due to dissection. A statistical comparison was also performed relating the traditional risk factors for TAD to other clinical and echocardiographic parameters: the diameter of the ascending aorta and the AAAC.The AAAC was found to be narrower statistically in the TAD group (α = 76.2° ± 17.5°) than it was in the AsAA group (α = 92.9° ± 13°) (P < 0.001). Furthermore, mean ascending aortic diameter (P = 0.019), the presence of a bicuspid aorta (P = 0.007) and aortic valve stenosis (P = 0.005) were higher in the AsAA group. According to multivariable analyses, a narrower AAAC is a significant predictor for the development of TAD (odds ratio 0.93, 95% confidence interval 0.91-0.95; P < 0.001). Overall hospital mortality from various causes including stroke, myocardial infarction, bleeding or renal failure was 13% in the TAD group and 7% in the AsAA group.According to this study, the AAAC was significantly smaller in aortic dissection patients than in aortic aneurysm patients. This may be related to higher shear stress and elevated pressure on the ascending aorta in patients with a narrower AAAC. Thus, a narrower AAAC may be an additional risk factor in the development of TAD. Therefore, we may need to be more careful in terms of looking for the development of aortic dissection in patients with narrower AAAC.

Brachiocephalic artery

10.1093/icvts/ivz144

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Obesity Does Not Affect Major Outcomes in Robotic Coronary Surgery

The Heart Surgery Forum (2023)

Emre Yaşar Zihni Mert Duman Muhammed Bayram Mete Gürsoy Ersin Kadiroğulları

Robotic-assisted coronary surgery is gaining attraction as an alternative to traditional open-heart procedures, offering potential benefits such as decreased mortality rates, shorter hospital stays, and reduced complications. This study aimed to investigate the outcomes of robotic-assisted coronary surgery, focusing particularly on the impact of obesity.A total of 210 consecutive patients underwent robotic-assisted coronary surgery over an eight-year period at a single institution. Patients were categorized based on body mass index (BMI), distinguishing between obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) groups. The analysis encompassed preoperative characteristics, operative factors, and postoperative outcomes.Comparisons between obese and non-obese patients revealed similar preoperative comorbidities. However, the operation time was prolonged in the obese group (p = 0.03). Major cardiac and cerebrovascular events, along with overall complications, displayed no significant disparities between the groups. Notably, superficial wound infections were more prevalent among obese patients (p = 0.03). Importantly, intensive care unit and hospital stay times were comparable between the two groups.Robotic-assisted coronary surgery demonstrates its potential as a viable alternative to conventional open-heart procedures, offering benefits such as reduced mortality rates, shorter hospital stays, and minimized perioperative complications. This study's findings underscore the feasibility and safety of this approach, with outcomes comparable between obese and non-obese patients.

10.59958/hsf.6791

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Effect of blood transfusion on octogenarians undergoing open heart surgery

The Annals of Clinical and Analytical Medicine (2023)

Mehmet Şimşek Barış Timur Zihni Mert Duman

10.4328/acam.21434

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Clinical Use of Tailored Computed Tomography to Prevent Poststernotomy Dehiscence

The Thoracic and Cardiovascular Surgeon (2021)

Zihni Mert Duman Barış Timur Çağdaş Topel Timuçin Aksu

Morphological and tissue density analysis of the sternum can be performed in the preoperative computed tomography (CT). The purpose of this study was to analyze morphology and tissue density of sternum in CT and effect for comparison sternal instability. Patients with sternal instability (n = 61) and sternal stability (n = 66) were enrolled in this study. All of the patients were studied using same thorax CT procedure. All the measurements were performed by one specific cardiovascular radiologist. The Hounsfield units (HUs) were measured in axial sections of the sternum trabecular bone. Sternal instability group mean HU was 75.36 ± 13.19 and sternal stability group HU was 90.24 ± 12.16 (p < 0.000). HU is the statically significant predictor of sternal instability. Our study showed a significant correlation between the mean HU value of sternum and sternal instability. We think that it is important to evaluate the existing thorax CT while performing preoperative risk analysis for sternal dehiscence.

Sternum

Hounsfield scale

Thorax (insect anatomy)

10.1055/s-0041-1736243

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Fate of the Patent False Lumen of the Descending Aorta After Surgical Treatment for Acute Type 1 Aortic Dissection

Brazilian Journal of Cardiovascular Surgery (2023)

Emre Yaşar Zihni Mert Duman Barış Timur Muhammed Bayram Mustafa Can Kaplan

This study aimed to investigate the factors affecting false lumen patency in the descending thoracic aorta among patients who underwent surgery for acute type 1 aortic dissection.A total of 112 patients with acute type 1 aortic dissection, with the flap below the diaphragm level, underwent surgery between January 2010 and September 2019. Of these, 60 patients who were followed up for ≥ 12 months and whose computed tomography scans were available were included in this study. The patients were divided into two groups: group I, consists of patent false lumen (n=36), and group II, consists of thrombosed false lumen (n=24). Demographic data, operative techniques, postoperative descending aortic diameters, reintervention, and late mortality were compared between the two groups.The mean follow-up period of all patients was 37.6±26.1 months (range: 12-104). The diameter increase in the proximal and distal descending aorta was significantly higher in the patent false lumen group (5.3±3.7 mm vs. 3.25±2.34 mm; P=0.015; 3.1±2.52 mm vs. 1.9±1.55 mm; P=0.038, respectively). No significant difference in terms of hypertension was found between the two groups during the follow-up period (21 patients, 58.3% vs. 8 patients, 33.3%; P=0.058). A total of 29 patients (48.3%) were found to be hypertensive in the postoperative period.After surgical treatment for acute type 1 aortic dissection, patients should be monitored closely, regardless of whether the false lumen is patent or thrombosed. Mortality and reintervention can be seen in patients with patent false lumen during follow-up.

Descending aorta

Lumen (anatomy)

Thoracic aorta

10.21470/1678-9741-2022-0257

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