25 results on '"YURTSEVEN, Nurgül"'
Search Results
2. Use of Endotracheal Tubes with Subglottic Drainage Reduces Ventilator-associated Pneumonia in Chronic Obstructive Pulmonary Disease Patients After Coronary Surgery.
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Düzyol, İpek Yakın, Yurtseven, Nurgül, Düzyol, Çağrı, and Köse, Abbas
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CHRONIC obstructive pulmonary disease , *VENTILATOR-associated pneumonia , *BODY surface area , *ENDOTRACHEAL suctioning , *ENDOTRACHEAL tubes , *CORONARY artery bypass , *RED blood cell transfusion - Abstract
Objectives: We investigated the effects of endotracheal tubes with subglottic drainage (SGAETT) on the incidence of ventilator-associated pneumonia (VAP) in patients with chronic obstructive pulmonary disease (COPD) undergoing coronary artery bypass grafting (CABG). Methods: The patients were assigned to one of two groups. Group 1 patients used a SGAETT (n=94); Group 2 controls received standard endotracheal tubes (n=100). The demographic data, number of coronary bypasses performed, and cross clamp (CC) and cardiopulmonary bypass (CPB) durations were recorded. Endotracheal aspiration samples were obtained from patients with suspected VAP in the intensive care unit (ICU). Intubation time, length of ICU and hospital stays, erythrocyte transfusion volume, enteral nutrition needs, transportation needs, and reintubation and sedation needs were recorded. Results: The VAP rate was 6.8% in Group 1 and 19% in Group 2 (p<0.05). Group 1 patients had lower body weight, smoking, and transportation needs; Group 1 patients also had shorter ICU and hospital stays but demonstrated a greater average body surface area, higher mean pulmonary arterial pressure, more-frequent peptic ulcers, higher mean pulmonary arterial pressure, and Group 1 patients were more likely to have ejection fractions (EFs) less than 40% (p<0.05). A logistic regression analyses found SGAETT independently reduced VAP independently (OR: 0.037) (p<0.05). Conclusion: SGAETT reduces the incidence of VAP in patients with COPD undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Outcomes of Norwood procedure with hypoplastic left heart syndrome: Our 12-year single-center experience
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Özdemir, Fatih, primary, Korun, Oktay, additional, Dedemoğlu, Mehmet, additional, Çiçek, Murat, additional, Biçer, Mehmet, additional, Yurdakök, Okan, additional, Fırat Altın, Hüsnü, additional, Hekim Yılmaz, Emine, additional, Yurtseven, Nurgül, additional, Ali Aydemir, Numan, additional, and Şaşmazel, Ahmet, additional
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- 2022
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4. The Effect of Preoperative Oral Chlorhexidine Rinse on Ventilator Associated Pneumonia and ICU Mortality After Open Heart Surgery
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Uğur, İbrahim, primary, Yurtseven, Nurgül, additional, Polat, Senem, additional, Yılmaz Ferhatoğlu, Sibel, additional, and Ocalmaz, Seyda, additional
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- 2021
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5. Determination of Mortality in Cardiac Surgery: Is Cardiac Surgery Scoring (CASUS) System Effective?
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Polat, Senem, primary and Yurtseven, Nurgül, additional
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- 2021
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6. Analysis of Articles on COVID-19: Is Scientific Productivity Parallel to Case Rates Across Countries?
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Yılmaz Ferhatoğlu, Sibel, primary and Yurtseven, Nurgül, additional
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- 2020
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7. The poor long-term outcomes of owl’s eye pulmonary reconstruction technique after arterial switch operation
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Dedemoğlu, Mehmet, primary, Korun, Oktay, primary, Coşkun, Gültekin, primary, Özdemir, Fatih, primary, Yurdakök, Okan, primary, Çiçek, Murat, primary, Biçer, Mehmet, primary, Yurtseven, Nurgül, primary, Şaşmazel, Ahmet, primary, and Aydemir, Numan Ali, primary
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- 2020
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8. Organ Dysfunction and Mortality Relationship in Patients with Extracorporeal Membrane Oxygenation After Pediatric Cardiac Surgery
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Sırakaya Erese, Nihal, primary, Yurtseven, Nurgül, additional, Hekim Yılmaz, Emine, additional, Yurdakök, Okan, additional, and Yaka, Suna, additional
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- 2020
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9. Atrial Fibrillation After Coronary Artery Bypass Surgery: Risk Factors
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Karakaş, Oya, primary, Yurtseven, Nurgül, additional, and Savaskan, Dilek, additional
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- 2020
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10. Intraoperative Flow Study Predicted the Postoperative Pulmonary Artery Pressure in the Bidirectional Glenn Operation
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Korun, Oktay, primary, Yücel, İlker Kemal, additional, Çiçek, Murat, additional, Altın, Hüsnü Fırat, additional, Yurdakök, Okan, additional, Kılıç, Yiğit, additional, Selçuk, Arif, additional, Yurtseven, Nurgül, additional, Şaşmazel, Ahmet, additional, and Aydemir, Numan Ali, additional
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- 2019
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11. A dramatic learning curve of extracardiac Fontan operation in the modern era
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Korun, Oktay, primary, Çiçek, Murat, additional, Yurdakök, Okan, additional, Hekim Yılmaz, Emine, additional, Çelebi, Ahmet, additional, Yurtseven, Nurgül, additional, Şaşmazel, Ahmet, additional, and Ali Aydemir, Numan, additional
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- 2019
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12. Kardiyak Cerrahide Mortalite Tayini: Kalp Cerrahi Skorlaması (CASUS) Sistemi Etkin mi?
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Polat, Senem and Yurtseven, Nurgül
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INTENSIVE care units , *CARDIAC surgery , *RECEIVER operating characteristic curves , *PREDICTION models , *MORTALITY - Abstract
Objective: This study was planned to evaluate effectiveness of cardiac surgery score (CASUS) system used for the prediction of mortality after the cardiac surgery and to compare it with EuroSCORE, a tested and approved method. Method: Fifty patients over the age of 18 who came to the intensive care unit (ICU) after open heart surgery and stayed in the ICU for more than 48 hours were prospectively included in the study. After the preoperative EuroSCORE evaluation of the patients, CASUS scoring systems were used for risk scoring from postoperative 0 day to the service or up to the 6th postoperative day (or possible mortality) in patients whose stay in ICU was prolonged. We evaluated the place of both models in the prediction of ICU mortality. Results: The study was conducted with 50 patients- 21 female, 29 male-, aged between 19 and 79 years (mean age: 60.38±12.50). Five (10%) cases exited.The areas under the ROC curve were estimated as follows: EuroSCORE, 45.3%; and for CASUS 0,1, and 2. day scores AUCs of ROC curve were 66,9%, 64,7%, and 79,8%, respectively. The CASUS 2nd day score was found to be valuable in predicting mortality (p<0.01). A statistically significant relationship was observed between the days of stay in the ICU and mortality. Conclusion: Our results show that the rate of the accurate prediction of mortality of CASUS is insufficient on postop 0th and 1st day; however CASUS score on postoperative 2nd day has sufficient.predictive accuracy EuroSCORE is not found effective in the prediction of mortality. It is observed that if the duration of stay in ICU is prolonged, it statistically significantly increases the risk of mortality. [ABSTRACT FROM AUTHOR]
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- 2021
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13. Pediyatrik Kardiyak Cerrahi Sonrası Ekstrakorporeal Membran Oksijenasyonu Uygulanan Hastalarda Organ Disfonksiyonu ve Mortalite İlişkisi.
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Erese, Nihal Sirakaya, Yurtseven, Nurgül, Yılmaz, Emine Hekim, Yurdakök, Okan, and Yaka, Suna
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BLOOD urea nitrogen , *CONGENITAL heart disease , *ASPARTATE aminotransferase , *ALANINE aminotransferase , *PEDIATRIC surgery - Abstract
Objective: TThe application of mechanical support devices such as extracorporeal membrane oxygenatior (ECMO) has increased with the increase in complex cardiac surgery operations in congenital heart diseases. Despite significant advances in ECMO techniques and methods, the prognosis is still poor. The aim of this study is to show the relationship between organ dysfunction and mortality in patients with veno-arterial (VA) ECMO after pediatric cardiac surgery. Method: Sixty-three patients in the pediatric cardiac ICU who had VA-ECMO and followed up up to 48 hours in our clinic, were retrospectively included in the study and two groups were formed as follows: Group 1: Patients exited within 30 days (n: 47), Group 2: Survived patients (n: 16). Along with the demographic data of the patients, ECMO placement time, creatinine, BUN (blood urea nitrogen), ALT (alanine aminotransferase), AST (aspartate aminotransferase), bilirubin, albumin and platelet counts were recorded. Results: While 36 patients (57.1%) left ECMO in our study group, 16 of these patients (16/63,25.4%) were discharged. A total of 47 patients (47/63, 74.6%) died. Although the number of patients who underwent univentricular repair (26/47,55.31%) in Group 1 was higher (n=5:31.25%) than Group 2, this difference was not significant (p>0.05). Postoperative ECMO was implanted in 27 patients (57.44%) in Group 1 and 4 patients (31.25%) in Group 2, and this difference was statistically significant (p<0.02). While levels of creatinine, BUN, ALT, AST were higher in Group 1 patients who had higher mortality rates, albumin and platelet values were lower than Group 2 (p<0.05). Conclusion: It has been determined that organ dysfunction parameters were found to be effective in showing mortality, mortality rates were higher among patients in whom ECMO was placed postoperatively. [ABSTRACT FROM AUTHOR]
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- 2020
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14. Koroner Arter Baypas Cerrahisi Sonrası Atriyal Fibrilasyon: Risk Faktörleri.
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Karakaş, Oya, Yurtseven, Nurgül, and Savaşkan, Dilek
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LENGTH of stay in hospitals , *CORONARY artery surgery , *CORONARY artery bypass , *CALCIUM antagonists , *HYPERTENSION - Abstract
Objective: The aim of this study was to determine the risk factors in atrial fibrillation (AF), which is the most common rhythm disorder observed after coronary artery bypass graft (CABG) surgery, and to show whether there is a correlation between C-reactive protein (CRP) and AF. Methods: A total of 250 patients who would undergo coronary artery surgery were retrospectively included in the study. Demographic data, peroperative and postoperative variables of all patients, daily CRP and AF follow-ups until the 6th postoperative day and treatment protocols of AF patients were recorded. Results: AF was detected in 43 (17.2%) of the patients who were followed up. It was found that there was a statistically significant relationship in the multivariate analysis between advanced age, hypertension (HT) and use of preoperative calcium channel blocker and AF (p<0.05). CRP values reached the highest value on the 2nd postoperative day. Although AF was seen in 14 patients (5.6%) in this period, no relation was found between increased CRP levels and the development of AF (p>0.05). It was observed that the length of intensive care and hospital stay of patients with AF was statistically significantly longer (p<0.05). Conclusion: It was found that older hypertensive patients who preoperatively used calcium channel blocker had a higher risk of developing AF. Duration of ICU and hospital stay was longer, and no correlation was found between AF and CRP. [ABSTRACT FROM AUTHOR]
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- 2020
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15. Relation of Troponin I Levels with Postoperative Mortality and Morbidity Rates in Patients Followed in Intensive Care Unit After Congenital Cardiac Surgery Whose Ages Between 7 Days and 16 Years Old
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Yılmaz Ak, Hülya, primary, Yıldız, Mustafa, additional, Yurtseven, Nurgül, additional, Özsoy, Deniz, additional, Okşen, Doğaç, additional, and Çetin, Hakkı Kürşat, additional
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- 2018
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16. Comparıson of Two Dıfferent Peep Levels in One Lung Ventilation
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Siyahkoç, İncifer, primary, Yurtseven, Nurgül, additional, Siyahkoç, Ercan, additional, Yaka, Suna, additional, and Okay, Tamer, additional
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- 2017
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17. Intraoperative Flow Study Predicted the Postoperative Pulmonary Artery Pressure in the Bidirectional Glenn Operation
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Korun, Oktay, Yücel, İlker Kemal, Çiçek, Murat, Altın, Hüsnü Fırat, Yurdakök, Okan, Kılıç, Yiğit, Selçuk, Arif, Yurtseven, Nurgül, Şaşmazel, Ahmet, and Aydemir, Numan Ali
- Abstract
Background: The aim of this study was to evaluate the predictability of postoperative pulmonary artery pressure (PAP) using intraoperative flow study in patients undergoing bidirectional Glenn operation.Methods: Patients who underwent Glenn operation under cardiopulmonary bypass (CPB) were included in the study. During the operation, after the completion of additional procedures under CPB, an intraoperative flow study was performed prior to Glenn anastomosis. After the completion of bidirectional Glenn, the patient was separated from the CPB and PAP was measured. The relationship between this pressure and flow study measurement was analyzed.Results: Nine patients who underwent bidirectional Glenn operation with additional procedures under CPB between July 2018 and January 2019 were included in the study. The median PAP was 9 mm Hg (interquartile range [IQR]: 7-10 mm Hg) in the flow study and 10 mm Hg (IQR: 8-11 mm Hg) after CPB, and the median difference between these pressures was 1 mm Hg (IQR: 1-3 mm Hg). There was a strong correlation between these two measurements (r= 0.732; P= .025).Conclusion: The results of this study show that PAP after the Glenn procedure can be estimated using an intraoperative flow study. We believe that this method may be useful in intraoperative decision-making for Glenn operation in single ventricular patients who require extensive pulmonary artery (PA) reconstruction due to limited PA development, branch PA stenosis, or nonconfluent PAs. Also, this method can be used as a sort of intraoperative pulmonary resistance reversibility study in patients with high preoperative pulmonary vascular resistance due to surgically correctable pulmonary venous hypertension.
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- 2020
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18. Açık Kalp Cerrahisi Sonrası Ventilatörle İlişkili ID Pnömoni: Risk Faktörleri.
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Köse, Abbas, Yurtseven, Nurgül, and Düzyol, İpek Yakın
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INTRA-aortic balloon counterpulsation , *OBSTRUCTIVE lung diseases , *VENTILATOR-associated pneumonia , *PRESSURE ulcers , *CARDIAC surgery , *NASOENTERAL tubes , *BLOOD filtration - Abstract
Objective: Ventilator-associated pneumonia (VAP) are among common infections encountered in intensive care units. The high mortality rate is important due to prolonged hospital stay and increased hospital costs. In this study, we aimed to determine the risk factors associated with VAP in patients who had undergone open heart surgery. Method: In this study, a total of 599 patients (178 female, and 421 male) who underwent elective open heart surgery were prospectively included in this study. Patients who could not be extubated after 48 hours were divided into two groups. Group 1: Patients with clinical suspicion of VAP and bacterial growth in their endotracheal aspirates (ETA) (n=29) Group 2: Control group (n=570). Results: In univariate analysis, age, Chronic Obstructive Pulmonary Disease (COPD) Pulmonary Hypertension (PHT), history of myocardial infarction (MI), low ejection fraction (EF), prolonged cross- clamp and pump times, inotropic support, presnce of intra-aortic balloon pump (IABP) and use of hemofiltration, atrial fibrillation, reintubation, enteral nutrition with nasogastric tube, reoperation, neurologic dysfunction, steroid use, blood and blood product use, hypoalbuminemia and presence of decubitus ulcer were detected as risk factors for VIP. According to logistic regression analysis duration of intubation longer than 72 hours, reintubation, COPD, previous MI, steroid use, AF neurologic dysfunction were determined as independent risk factors for VAP. Conclusion: In the patient population consisting of patients with cardiac surgery, keeping the invasive mechanical ventilator support as short as possible, reducing the need for reintubation by extubation in optimal time, ensuring complete haemodynamic stability, preoperative preparation of the patient preoperatively, prevention of postoperative haemodynamic instability during surgery, and reduction of VAP. [ABSTRACT FROM AUTHOR]
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- 2019
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19. Risk Factors for Sepsis Following Congenital ID eart Surgery.
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Yavuz, Yasemin, Yurtseven, Nurgül, Aydemir, Numan Ali, Korun, Oktay, and Şimşek-Yavuz, Serap
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SEPSIS , *DISEASE risk factors , *INTENSIVE care units , *LENGTH of stay in hospitals , *SURGICAL emergencies , *CARDIOPULMONARY bypass ,STERNUM surgery - Abstract
Objective: This study aims to evaluate the incidence and risk factors associated with sepsis in pediatric patients who underwent congenital heart surgery. Method: A total of 289 patients were prospectively enrolled in this study. Patients were divided into two groups according to the Society of Critical Care Medicine (SSCM) diagnostic criteria as Group I including 28 patients who fulfilled the criteria for sepsis and Group II including 261 patients without diagnosis of sepsis. Demographic information, type of operation, complexity, duration of preoperative hospitalization (>5 days) and intensive care unit (ICU) stay, requirement for mechanical ventilation (MV), history of pulmonary hypertension (PHT), and requirement for emergency surgery, total cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times. During the postoperative period delayed sternal closure, duration of mechanical ventilation, the need for reintubation, and need for reoperation were also recorded. Results: The incidence of sepsis was 4.74%. The mortality rate in septic patients was 32%. Factors associated with sepsis were younger age, low body weight, duration of preoperative hospitalization and ICU stay, preoperative requirement for MV, palliative and emergency interventions, history of PHT, prolonged MV, reintubation, and reoperation. Multivariate analysis identified reintubation and duration of MV as the major risk factors for sepsis. Conclusion: Serious infectious problems, such as sepsis, are encountered due to inadequate development of immune resistance mechanisms in pediatric patients. Appropriate preoperative preparation of patients for surgery, reducing the length of stay in the hospital and in the ICU, and reducing the need for reintubation by extubating the patients for an optimal period, would reduce the mortality rate due to sepsis. [ABSTRACT FROM AUTHOR]
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- 2019
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20. Tek Akciğer Ventilasyonunda İki Farklı PEEP Düzeyinin Etkilerinin Karşılaştırılması.
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SİYAHKOÇ, İncifer, YURTSEVEN, Nurgül, SİYAHKOÇ, Ercan, YAKA, suna, and OKAY, Tamer
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Objective: This study aims to analyze the effects of two different positive end- expiratory pressure (PEEP) levels during single lung ventilation with low tidal volume (TV) on respiration and hemodynamics in patients undergoing thoracotomy. Material and Methods: After the Hospital Education Planning Board approval and written consent were obtained 40 patients scheduled for thoracotomy were enrolled in the study. When all patients were intubated with double- lumen endotracheal tube and one-lung ventilation (OLV) was initiated, the patients were randomized into two groups. Group 1 (n: 20) consisted of patients who underwent lung ventilation with 6 ml/kg TV and 5 cm H2O PEEP; and Group 2 (n: 20) consisted of patients who underwent lung ventilation with 6 ml/ kg TV and 10 cm H2O PEEP. Arterial blood gas samples were obtained from the patients during the study, and mean arterial pressure, heart rate, partial oxygen pressure (pO2), partial carbondioxide pressure (pCO2), peak airway pressures (PİP), plateau pressure values were recorded at 7 different time points namely T0: Supine position, before the induction, T1: double lung ventilation after induction, T2: OLV 15 minutes, T3: OLV 30 minutes, T4: OLV 45 minutes, T5: pre-extubation, supine position, T6: Postoperative 6th hour. Results: Mean arterial pressure and heart rate values were significantly lower at T1, T2, T3 ve T4 time points in Group 2; however, this decrease was within physiological limit. Group 2 patients had significantly higher PaO2 and lower PaCO2 values. At time points of T2, T3 and T4 when the patients were under OLV, PiP and plateau pressures in Group 2 patients were significantly higher (p<0.05). Conclusion: It was concluded that delivery of low tidal volume and 10 cm H2O PEEP to the ventilated lung during thoracotomy made positive contributions to oxygenation without any adverse effects on hemodynamic, and respiratory mechanisms. [ABSTRACT FROM AUTHOR]
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- 2017
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21. POSTOPERATİFKARDİYAK CERRAHİDE AKILCI İNOTROP KULLANIMI.
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Yurtseven, Nurgül
- Abstract
Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2018
22. PEDİYATRİK KARDİYAK CERRAHİ SONRASI EKSTRAKORPOREAL MEMBRAN OKSİJENATÖRÜ TAKILAN HASTALARDA ORGAN DİSFONKSİYONU VE MORTALİTE İLİŞKİSİ.
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Erese, Nihal Sırakaya, Yurtseven, Nurgül, Coşkun, Filiz, Karadağ, Hüseyin, and Yaka, Suna
- Abstract
Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2018
23. LOKAL ANESTEZİĞE BAĞLI METHEMOGLOBİNEMİ TEDAVİSİNDE ASKORBİK ASİT KULLANIMI.
- Author
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Baş, Hilal, Kul, Berrin, Akgün, Gökmen, Yılmaz, Emine Hekim, and Yurtseven, Nurgül
- Abstract
Copyright of Journal of Pediatric Emergency & Intensive Care Medicine / Çocuk Acil ve Voğun Bakım Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2018
24. Outcomes of Norwood procedure with hypoplastic left heart syndrome: Our 12-year single-center experience
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Fatih Özdemir, Oktay Korun, Mehmet Dedemoğlu, Murat Çiçek, Mehmet Biçer, Okan Yurdakök, Hüsnü Fırat Altın, Emine Hekim Yılmaz, Nurgül Yurtseven, Numan Ali Aydemir, Ahmet Şaşmazel, Biçer, Mehmet, Özdemir, Fatih, Korun, Oktay, Dedemoğlu, Mehmet, Çiçek, Murat, Yurdakok, Okan, Altın, Hüsnü Fırat, Yılmaz, Emine Hekim, Yurtseven, Nurgül, Aydemir, Numan Ali, Sasmazel, Ahmet, and Koç University Hospital
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Pulmonary and Respiratory Medicine ,Hypoplastic left heart syndrome ,Inter-stage mortality ,Norwood procedure ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Background: in this study, we aimed to analyze the predictors and risk factors of mortality in patients who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome. Methods: between January 2009 and December 2020, a total of 139 patients (95 males, 44 females) who underwent Norwood I procedure with the diagnosis of hypoplastic left heart syndrome in our center were retrospectively analyzed. Results: the median birth weight was 3,200 (range, 3,000 to 3,350) g and the median age at the time of operation was seven (range, 5 to 10) days. Pulmonary flow was achieved with a Sano shunt in the majority (72%) of patients. Survival rate was 41% after the first stage. Reoperation for bleeding (p=0.017), reoperation for residual lesion (p=0.011), and postoperative peak lactate level (p=0.029), were associated with in-hospital mortality. Nineteen (33%) of 57 patients died before the second stage. Thirty-three (58%) patients underwent second stage, and survival after the second stage was 94%. Thirteen patients underwent third stage, and survival after the third stage was 85%. Estimated probability of survival at six months, and one, two, three, and four years were 33%, 33%, 25%, 25%, and 22% respectively. Conclusion: hospital and inter-stage mortality rates are still high and this seems to be the most challenging period in term of survival efforts of the patients with hypoplastic left heart syndrome. Early recognition and reintervention of anatomical residual defects, close follow-up in the inter-stage period, and the accumulation of multidisciplinary experience may help to improve the results to acceptable limits. / Amaç: bu çalışmada, hipoplastik sol kalp sendromu tanısıyla Norwood I işlemi uygulanan hastalarda mortalitenin öngörücüleri ve risk faktörleri incelendi. Ça¬lış¬ma pla¬nı: Ocak 2009 ve Aralık 2020 tarihleri arasında merkezimizde hipoplastik sol kalp sendromu tanısıyla Norwood I işlemi uygulanan toplam 139 hasta (95 erkek, 44 kadın) retrospektif olarak incelendi. Bulgular: medyan doğum ağırlığı 3200 (dağılım, 3000-3350) g ve ameliyat sırasında medyan yaş yedi (dağılım, 5-10) gün idi. Hastaların büyük kısmında (%72) pulmoner akım, Sano şant ile sağlandı. İlk aşama sonrası sağkalım %41 idi. Kanama nedeniyle tekrar ameliyat (p=0.017), rezidü anatomik lezyon nedeniyle tekrar ameliyat (p=0.011) ve ameliyat sonrası birinci gün pik laktat seviyesi (p=0.029) hastane mortalitesi ile ilişkili idi. Taburcu edilen 57 hastanın 19’u (%33) ikinci aşamaya ulaşamadan kaybedildi. Otuz üç (%58) hastaya ikinci aşama ameliyatı uygulandı ve ikinci aşama sonrası sağkalım %94 idi. On üç hastaya üçüncü aşama ameliyatı uygulandı ve üçüncü aşama sonrası sağkalım %85 idi. Altı ay ve birinci, ikinci, üçüncü ve dördüncü yılda tahmini sağkalım olasılığı sırasıyla %33, %33, %25, %25 ve %22 idi. So¬nuç: hastane ve aşamalar arası mortalite oranları halen yüksek olup, hipoplastik sol kalp sendromu tanılı hastaların sağkalma çabalarındaki en zorlayıcı zaman dilimi olarak görünmektedir. Anatomik rezidü defektlerin erken tanılanması ve erken yeniden girişim yapılması, aşamalar arası dönemde yakın takip ve multidisipliner birikim ve tecrübe sonuçların kabul edilebilir seviyelere ulaşmasına yardım edebilir., NA
- Published
- 2022
25. A novel fontan Y-graft for interrupted inferior vena cava and azygos continuation
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S Samaneh Lashkarinia, Murat Cicek, Banu Kose, Mohammad Rezaeimoghaddam, Emine Hekim Yılmaz, Numan Ali Aydemir, Reza Rasooli, Sercin Ozkok, Nurgul Yurtseven, Hasan Erdem, Kerem Pekkan, Ahmet Sasmazel, Lashkarinia, S. Samaneh, Pekkan, Kerem (ORCID 0000-0001-7637-4445 & YÖK ID 161845), Rezaeimoghaddam, Mohammad, Rasooli, Reza, Çicek, Murat, Köse, Banu, Yılmaz, Emine Hekim, Aydemir, Numan Ali, Özkök, Serçin, Yurtseven, Nurgül, Erdem, Hasan, Sasmazel, Ahmet, Graduate School of Sciences and Engineering, College of Engineering, and Department of Mechanical Engineering
- Subjects
Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,Intratrial ,Y-Graft ,1004 Medical Biotechnology ,Respiratory System ,Hemodynamics ,Single Ventricle ,1103 Clinical Sciences ,Vena Cava, Inferior ,Computational Fluid Dynamics ,Pulmonary Artery ,Extracardiac ,Fontan Procedure ,Total Cavopulmonary Connection ,Cardiac and cardiovascular systems ,Respiratory system ,Surgery ,Patient-Specific Analysis ,Pre-Surgical Planning ,Humans ,Total cavopulmonary connection ,Computational fluid dynamics ,Y-graft ,Fontan procedure ,Pre-surgical planning ,Single ventricle ,Patient-specific analysis ,Cardiology and Cardiovascular Medicine - Abstract
Objectives: to evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. Methods: for 9 patients, aged 2 to 18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. Results: the proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. Conclusions: the new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development., European Union (EU); Horizon 2020; European Research Council (ERC); Proof of Concept Grant; BloodTurbine; ERC Starting Grant; Scientific and Technological Research Council of Turkey (TÜBİTAK); 1003 Priority-Research Program Grant
- Published
- 2022
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