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Background: In this study, we aimed to investigate the prognostic value of the tricuspid annular plane systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio in right ventricular failure patients undergoing left ventricular assist device implantation. Methods: Between February 2013 and February 2020, a total of 75 heart failure patients (65 males, 10 females; median age: 54 years; range, 21 to 66 years) were retrospectively analyzed. The prognostic value of TAPSE/PASP ratio was assessed using the multivariate Cox regression models and confirmed using the Kaplan-Meier analyses. Results: Forty-one (55.4%) patients had an ischemic heart failure etiology. The indication for assist device implantation was bridge to transplant in 64 (85.3%) patients. The overall survival rates at one, three, and five years following left ventricular assist device implantation were 82.7%, 68%, and 49.3%, respectively. Right ventricular failure was observed in 24 (32%) patients during follow-up. In the multivariate analysis, TAPSE/PASP was found to be independently associated with postoperative right ventricular failure (HR: 1.63; 95% CI: 1.49-2.23). A TAPSE/PASP of 0.34 mm/mmHg was found to be the most accurate predictor value, with lower ratios correlating with right ventricular failure. The Kaplan-Meier analysis showed a better overall survival using a TAPSE/PASP ? of 0.34 mm/mmHg (p Conclusion: A lower TAPSE/PASP ratio, particularly lower values than 0.34 mm/mmHg, strongly predicts right ventricular failure after left ventricular assist device implantation in patients with advanced heart failure.

Objective Deep venous thrombosis (DVT) is associated with a state of increased inflammation at the time of diagnosis as either a cause or consequence. The neutrophil-lymphocyte ratio (NLR) and the platelet-lymphocyte ratio (PLR) are easy-to-obtain, low-cost biomarkers of systemic inflammation. The objective of this study was to determine whether these two ratios at the time of diagnosis can be an indicator of thrombus burden in terms of thrombus location in DVT. Methods Patients with a diagnosis of DVT confirmed with venous Doppler ultrasound in a single referral center for cardiovascular diseases between 2014 and 2018 were retrospectively analyzed. Of 1852 patients, 933 with blood counts at time of diagnosis were included. The NLR and PLR were calculated from blood count results. Patients were categorized according to the level of thrombus and the number of vein segments involved as evidenced by Doppler ultrasound findings. Results Iliac, femoral, popliteal, and crural groups had a mean NLR of 5.07, 4.18, 3.59, and 3.24, respectively (P = .002), and a mean PLR of 1.82 × 107, 1.76 × 107, 1.47 × 107, and 1.64 × 107, respectively (P = .011). Patients with proximal DVT had a higher mean NLR (4.40 ± 4.28 vs 3.54 ± 3.55; P = .05) and PLR (1.77 × 107 ± 1.3 × 107 vs 1.49 × 107 ± 1.08 × 107; P = .03) than patients with distal DVT. NLR increased with the number of vein segments involved (P = .001), but this correlation did not exist with PLR (P = .097). Conclusions A state of inflammation, demonstrated by NLR and PLR, at the time of diagnosis in DVT patients correlates with disease burden in terms of thrombus location. Further studies are required to assess the clinical value of NLR and PLR at the bedside.

Introduction: Pulmonary arterial hypertension (PAH) is an important risk factor for increased mortality and morbidity during mitral valve surgery. In this study, we analysed the haemodynamic effects of the prostaglandin analogue iloprost in patients with PAH. Patients and Methods: We retrospectively analysed patients with PAH who were undergoing mitral valve surgery and had received intravenous iloprost therapy at our hospital from 1 January 2003 to 31 March 2013. Systemic and pulmonary arterial pressures were measured with catheterisation. The haemodynamic parameters were administered preoperatively and at 0 hours and 24 hours postoperatively. Results: A total of 135 patients had undergone mitral valve operations, of whom 78 patients were administered iloprost during the study period. Of all the cases, 29.9% were male and the average patient age was 54.45 ± 12.48 years. A comparison of the preoperative, hour 0 and hour 24 baseline parameters showed that pulmonary artery pressure and blood pressure statistically significantly decreased at postoperative hour 24 (p< 0.05). Age, preoperative EF and revisions were found to be statistically significant risk factors for mortality (p< 0.0001). Pulmonary pressures did not affect mortality and were not classified as risk factors. Conclusion: Iloprost treatment might improve postoperative outcomes in patients with high pulmonary arterial pressures and with decreasing pulmonary arterial pressures in the early postoperative period. Treatment with iloprost during the mitral valve replacement decreases high pulmonary arterial pressures and the peroperative mortality risk.

Objectives To evaluate the cost of healthcare with respect to the quality of anticoagulation in patients with deep vein thrombosis (DVT) treated with warfarin in daily practice via the database analysis of a tertiary care center in the period 2010 to 2013. Methods Of 258 307 records in total, 42 582 unique patients with DVT and 32 012 patients with international normalized ratio (INR) measurements were included. Overall, 6720 unique patients with DVT diagnosis and one or more INR measurements were identified, and the records of 4377 out of 6720 unique patients were validated and included in the analysis data set. The cost analysis was based on direct medical costs from the payer’s perspective. Cost items were related to healthcare resource utilization (inpatient and outpatient services) during the study period, which provided a basis for calculation of per-patient, outpatient, inpatient, and total direct medical costs. Results Mean outpatient, inpatient, and total hospital admission costs were $578, $2195, and $2785, respectively, for patients with time in the therapeutic range of 70% or more, whereas the same costs were $571, $2163, and $3192, respectively, for patients with time in the therapeutic range of less than 70%. Conclusions Our findings for a retrospective cohort of patients with DVT undergoing warfarin therapy reveal that patients spent 70% or more, as opposed to less than 70%, of follow-up time within the therapeutic INR range and that outpatient care, as opposed to inpatient care, was associated with lower healthcare costs. Given the significant contribution that hospital stay makes to the cost burden of DVT, our findings also highlight the association between poor warfarin anticoagulant control and increased hospitalization costs.

Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment in cardiogenic and respiratory shock. It is prone to various complications, infection being among the most frequent. This study aims to define the prevalence and characteristics of infections in ECMO patients in a tertiary care center for cardiac diseases. Methods: All ECMO patients between 2012 and 2016 in a single cardiac center were retrospectively included. Demographic data, ECMO indications, type, site, duration, and infection-related data were recorded. Data were analyzed among all patients and separately between pediatric and adult patient groups. Results: One hundred and twenty-six patients, 66 (53.4%) pediatric and 60 (47.6%) adult, received ECMO within the study period. Mean age was 3.54±4.27 years in the pediatric group and 54.92±15.57 years in the adult group. The main indication for ECMO was postcardiotomy shock (77.8%). Forty-six (36.5%) of all cases developed a culture-proven nosocomial infection with a rate of 49/1000 ECMO days. Infection was associated with > 5 days of ECMO duration and hemodialysis requirement in all patients and lower age in the pediatric group. The most frequent infection site was the lower respiratory tract (14.3%), while the most common isolated organisms were Klebsiella (8.7%) and Streptococcus (4.8%) species. Conclusion: The respiratory tract is the most common site of infection, however, all sites impose a threat to recovery, with longer treatment durations required for patients with culture-proven infections. A better understanding of the infectious spectrum and its effect on the mortality and morbidity is required for more successful treatment of ECMO patients.

Chronic thromboembolic pulmonary hypertension is an underdiagnosed and potentially fatal subgroup of pulmonary hypertension, if left untreated. Clinical signs include exertional dyspnea and non-specific symptoms. Diagnosis requires multimodality imaging and heart catheterization. Pulmonary endarterectomy, an open heart surgery, is the gold standard treatment of choice in selected patients in specialized centers. Targeted medical therapy and balloon pulmonary angioplasty can be effective in high-risk patients with significant comorbidities, distal pulmonary vascular obstructions, or recurrent/persistent pulmonary hypertension after pulmonary endarterectomy. Currently, there is a limited number of data regarding novel coronavirus-2019 infection in patients with chronic thromboembolic pulmonary hypertension and the changing spectrum of the disease during the pandemic. Challenging times during this outbreak due to healthcare crisis and relatively higher case-fatality rates require convergence; that is an ultradisciplinary collaboration, which crosses disciplinary and sectorial boundaries to develop integrated knowledge and new paradigms. Management strategies for the "new normal" such as virtual care, preparedness for further threats, redesigned standards and working conditions, reevaluation of specific recommendations, and online collaborations for optimal decisions for chronic thromboembolic pulmonary hypertension patients may change the poor outcomes.

WOS: 000375094600020, PubMed ID: 27111324, Heart failure is a progressive disease. A considerable number of patients eventually reach an advanced or terminal phase, in spite of developments in diagnostic procedure, alternative treatments that can slow progression, management, and follow-up. In addition to palliative care of patients in the terminal phase, accurate recognition of advanced disease is vital in the determination of therapeutic options. Overall management of patients with heart failure requires the collaboration of professionals from multiple disciplines. Still, patients with advanced heart failure should be managed by a "heart team," as indicated by guidelines; communication and collaboration among cardiologists, cardiovascular surgeons, and other medical staff responsible for patient care is necessary. While our country has physicians experienced in the management of patients with advanced heart failure, these professionals are not distributed evenly across the country, and equitable access to therapeutic options is not provided. Hence, progress has yet to be made regarding appropriate referrals and patient circulation. The aims of the present consensus report are to strengthen the connection between certified, experienced centers and those that care for patients irrespective of disease phase and healthcare staff, as well as to raise awareness and provide information regarding conditions in Turkey.

Fibromuscular dysplasia is rarely biopsied. Progesterone receptor expression in myofibroblastic cells is useful for the histopathological evaluation in difficult-to-diagnose cases. Herein, we report two unusual cases of fibromuscular dysplasia in which progesterone receptor expression was shown in vessel sections.

OBJECTIVE: Pump thrombosis in left ventricular assist device (LVAD) patients is an important cause of mortality and morbidity. Inflow cannula migration is a predisposing factor for pump thrombosis. Telecardiographic measurements can be used to follow up apical cannula deviation. In this study, we aimed to evaluate the migration of the inflow cannulas in patients with LVADs using angle measurements on telecardiograms METHODS: Twenty-three patients who were implanted left ventricular assist devices in our clinic between February 2013 and April 2016 were included in our study. During the first year of follow-up, changes in angle measurements on postoperative 1st, 3rd, 6th, and 12th month telecardiograms were compared against the incidence of device thrombus and serum Lactate Dehydrogenase (LDH) levels. RESULTS: Patients who were diagnosed with device thrombosis had more change in inflow cannula angles than patients without device thrombus (p

Objective To evaluate the international normalized ratio (INR) monitoring patterns in patients with deep vein thrombosis. Methods Of 32,012 patients with ≥1 outpatient INR measurement and 42,582 patients with confirmed deep vein thrombosis diagnosis registered to our hospital between 1 January 2010 and 31 December 2013, 6720 records were identified to have both deep vein thrombosis and international normalized ratio measurement, and 4.377 out of 6.720 single patient records were determined to be statistically analyzable. Results Median INR measurement frequency was 6.47 times/year and patients had INR levels of 2–3 in 34.3% of follow-up time. Having ≥70% vs. Conclusion Our study revealed only one-third of the follow-up time to be spent within therapeutic INR, association of INR therapeutic range with lesser number of hospital admissions and INR monitoring frequency of 6.47 times/year despite lack of stable INR control in most of the deep vein thrombosis patients.

Background This study aims to investigate the effects of partial pressure of venous-arterial carbon dioxide changes in the early period after cardiopulmonary bypass in patients who did or did not receive inotropic support therapy and the effect of these changes on tissue perfusion. Methods A total of 100 consecutive patients (70 males, 30 females; mean age 61.8±2.3 years; range, 20 to 75 years) who underwent open heart surgery were divided into two groups as those who did not receive any inotropic agent (group 1, n=50) and those who received at least one inotropic agent (group 2, n=50) during the early postoperative period. Heart rate, blood oxygen saturation level, mean arterial pressure, central venous pressure and urine volume, lactate and base excess levels were recorded during the postoperative first 24 hours. At the same timeframe, partial pressure of venous-arterial carbon dioxide level was calculated from central venous and peripheral blood samples. Results In both groups, partial pressure of venous-arterial carbon dioxide were significantly higher in the postoperative fourth hour compared with basal values. This significant difference continued for the postoperative first 24 hours. Partial pressure of venous-arterial carbon dioxide in group 2 was significantly higher at the 12th-hour measurement (p=0.002). Lactate levels at zeroth and eighth hours were significantly higher in group 2 (p=0.012 and p=0.017, respectively). Fourthhour urine excretion volumes were significantly lower in group 1 (p=0.010). Mean arterial pressure at zeroth, 12th and 20th hours was significantly higher in group 2 (p=0.001, p=0.016, and p=0.027, respectively). At the eighth-hour measurement, a positive weak relationship was detected between partial pressure of venousarterial carbon dioxide and lactate levels (r=0.253 and p=0.033). Conclusion This study demonstrated that partial pressure of venous-arterial carbon dioxide increased in the first few hours and remained to be high for 24 hours after cardiopulmonary bypass independently of the use of inotropic support. However, in the postoperative period, even after lactate and base excess levels return to baseline values, partial pressure of venous-arterial carbon dioxide may continue to remain at high values, which may indicate impaired perfusion in some tissues.

Aim: Thoracic epidural analgesia (TEA) in cardiac surgery provides stable hemodynamics and postoperative analgesia by reducing stress response. The aim of this study was to investigate the effects of TEA in coronary artery bypass grafting (CABG) on postoperative pain, myocardial protection, intensive care unit (ICU) and hospital length of stay. Methods: After receiving approval from the hospital scientific committee and obtaining written informed consent from the participants, 40 patients, who were undergoing elective CABG, were included in the study. The patients were prospectively randomized into two groups as TEA group (n=20) and control group (n=20). Epidural catheters were placed one day before surgery at the T5-T6 level, levobupivacaine 2 µg/mL and fentanyl 5 mL/hr infusions were initiated in the ICU. Control group received intravenous infusion of fentanyl 8 µg/kg/hr. Infusions continued for 24 hours in both groups. Results: Time to extubation was shorter, postoperative hypertension was less frequent and pain scores were lower in TEA group than in control group (p

Objectives Although coronary angiography (CAG) is generally performed to rule out coexisting coronary artery disease in patients with cardiac myxoma, its necessity to evaluate vascular supply of the myxoma is debatable. The aim of this article is to evaluate clinical experience and CAG findings in our patient group. Methods This retrospective analysis was performed in 46 patients (17 men, mean age 57.7 ± 8.6 years), who underwent surgery with an indication for cardiac myxoma between 2004 and 2016 with a CAG performed preoperatively. All CAGs were evaluated in a blinded manner by a cardiac surgeon and a cardiologist separately. Correlations between the presence and pattern of feeding vessels, presence of an arteriocavity fistula (ACF), coronary arterial dominance, size of mass and clinical presentations were analysed. Results Coronary artery disease defined as >50% obstructive lesions was detected in 10 patients (21.7%). The tumour diameter was found to be significantly higher in patients who had an ACF and a dual-feeding artery (P = 0.049 and P = 0.0001, respectively). Additionally, there was a significant relationship between the presence of dual-feeding vessels and ACF (P = 0.014). ROC analysis revealed a cut-off point of 27 mm in diameter based on the presence of an ACF and a dual-feeding artery. In cases with a diameter of 27 mm or above, the risk of existence of an ACF was 4.68-fold greater, with a confidence interval of 95%, and a dual-feeding pattern was seen in all of them. Conclusions This study suggests that preoperative CAG can be considered to detect feeding vessels that may lead to a steal phenomenon, which may alter the management in patients with myxoma greater than 27 mm in diameter.

Amac: Koroner arter cerrahisinde gastrointestinal kompli- kasyonlar ender gorulur, ancak mortalitesi oldukca yuksek- tir. Hastalarin preoperatif ozellikleri, yandas hastaliklar ve kardiyopulmoner baypasin etkileri ile postoperatif surecte cesitli patolojileri iceren gastrointestinal komplikasyonlar gelismektedir. Bu retrospektif calismada amacimiz koroner arter cerrahisi geciren hastalarda preoperatif ozellikleri, peroperatif ve postoperatif klinik verileri degerlendirerek, gastrointestinal komplikasyonlarin gelisimi acisindan risk faktorlerini belirlemeye calistik.

Cardiac cachexia and low serum albumin levels are poor prognostic signs in advanced heart failure, while overweight patients or patients who gain weight after treatment have more favourable outcomes. Weight gain following LVAD implantation is common, while the dynamic changes in body mass or serum proteins have not been studied adequately. Our aim was to study short-term changes in serum albumin, total protein and body weight following LVAD implantation and to compare these changes with heart failure patients treated medically.A total of 15 patients scheduled for LVAD implantation and 15 patients receiving medical treatment were prospectively enrolled. Anthropometric and laboratory data for the patients were obtained at baseline and at first and sixth months after LVAD implantation.Anthropometric, demographic and clinical characteristics between two groups were similar at baseline. Both serum albumin (3.59±0.71 vs. 4.17±0.46g/dl, p=0.01) and total protein (6.45±0.80 vs. 7.12±0.35g/dl, p0.01) levels were significantly lower in LVAD group at baseline. Both total protein and serum albumin levels increased significantly in LVAD group (final total protein 7.60±0.62g/dl and serum albumin 4.20±0.46g/dl; p0.01 for both), while there was a nonsignificant small decrease in serum albumin in medical group. The change in serum albumin, but not total protein was significantly different between LVAD and medical groups at the sixth month. Body weight initially decreased in LVAD group at first month but was nonsignificantly higher compared to baseline and medical group at the sixth month. There was a moderate correlation between the percentage weight gain and percentage increase in serum albumin in LVAD group at six months (r=0.44).In suitable patients with advanced heart failure, LVAD treatment can correct hypoalbuminaemia associated with heart failure within six months after implantation.

Introduction: Aortic valve replacement (AVR) is set after the various factors affecting survival after surgery is not much knowledge about the factors affecting the quality of life. In addition to this are difficult to assess quantitatively the quality of life. In this study we in patients undergoing AVR, early post-operative differences in aortic pathology we investigated whether the effect on quality of life.Patients and Methods: In this study between December 2007-January 2009 Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, 25 patients were enrolled who underwent isolated AVR. According to the pathology of aortic valve insufficiency and stenosis in these patients were divided into groups. Pre-operative echocardiography and 3rd month after surgery were evaluated. Quality of life as the Short Form-36 (SF-36) have been used. SF-36 quality of life in post-operative 3rd month test was performed in all patients.Results: The SF-36 quality of life in patients with test results were statistically examined both aortic stenosis and aortic insufficiency group of physical function, general health, vitality, role limitations due to physical and emotional problems and mental health showed significant improvement in terms of post-operative. However, physical functioning, role limitations (physical and emotional), pain, general health, vitality, social functioning, mental health both in terms of pre-operative and post-operative comparison of data between the patients with aortic insufficiency and aortic stenosis difference was found.Conclusion: Early post-operative period in patients undergoing AVR on quality of life improvement was seen in all eight parameters, preoperative pathology, no difference was found among patients with aortic insuffuciency or aortic stenosis.

Introduction: The aim of this study is to evaluate the long term results of de Vega annuloplasty on ventricular functions in patients undergoing mitral valve replacement due to mitral valve pathology and functional tricuspid regurgiatiton.Patients and Methods: Eighty six patients who underwent mitral valve replacement in our clinic, during January 2008-June 2008 were involved in the study. The patients were grouped into two according to the presence of tricuspid pathology and annuloplasty. The demographic data and 6th and 24th month echocardiographic follow up were recorded.Results: First group consisted of 49 patients with pure mitral valve replacement patients and second group consisted of 37 patients that had tricuspid annuloplasty with mitral valve replacement. The demographic data and follow up echocardiographic results were compared. The statistical analysis showed that the patients with tricuspid regurgitation and recieved an annuloplasty had similiar ventricular functions with those who had pure mitral replacement. More significantly, in patients who recieved an annuloplasty with preoperative high pulmonary artery pressure and central venous pressure and bigger right atrial diameter, the ventricular findings in follow up were similiar with the pure mitral valve pathology.Conclusion: Tricuspid de vega annuloplasty is effective in functional tricuspid valve regurgitation. Long term follow up showed that ventricular findings were similiar with those who had only pure mitral pathology and mimimal regurgitation. Preoperative ejection fraction and grade of regurgiatiton is important in the decision making to perform annuloplasty.

Hydatidosis is a serious parasitic infection in endemic areas. A rare presentation is pulmonary arterial cysts causing thromboembolic pulmonary hypertension. We report the case of a young man who presented with clinical and radiological findings of thromboembolic pulmonary hypertension. The patient was found to have hydatid cysts in both pulmonary arteries and in the right ventricular outflow tract. To remove all cysts without causing rupture, anaphylactic shock or systemic emboli, placing the patient under cardiopulmonary arrest was necessary, and in the case of pulmonary arterial involvement, total circulatory arrest was necessary. The cysts were removed successfully, and the patient survived the operation. The patient is being followed up on albendazole treatment. Myocardial preservation and management of total circulatory arrest are the cornerstones of a successful surgical outcome.

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.

Objective : The goal was to review our experience in the management of carotid body tumours. Material and methods : A retrospective study was performed of patients in whom carotid body tumour was diagnosed between 1998 and 2005. Data were retrieved from hospital discharge files. Results : Fourteen patients were operated on. There were five patients in Shamblin class I, 4 in class II, and 5 in class III. Duplex examination was performed in all patients. Computerized tomography scans were performed in eight (57%) patients and magnetic resonance imaging scans in five patients (36%). Angiography was performed in all patients, pre- operative embolization was attempted in 5 (36%). The blood loss for these patients was not less than for those without embolization. Three patients (21%) had postoperative cranial nerve deficits. All the deficits resolved. The internal carotid artery was injured in two patients and the external carotid artery was injured in three patients (36%). No stroke occured. Conclusion : Surgical resection is the treatment of choice for carotid body tumours. Observation of these tumours is not recommended because progressive growth is associated with increased risk of neurological deficits. Early surgical man- agement is recommended to avoid neurological deficit due to a Shamblin class III tumour. We also do not recommend embolization.

Kalp yetersizliği ilerleyici bir hastalıktır. Tanı, tedavi ve takibindeki tüm gelişmelere ve hastalık sürecini yavaşlatabilen alternatiflere rağmen, hastaların önemli bir kısmı er ya da geç ileri evre ya da terminal evreye ulaşır. Terminal evredeki hastanın palyatif bakımının yanı sıra ileri evre hastanın dikkatli tanınması, bu hastalara yönelik tedavi seçeneklerinin göz önüne alınması bakımından hayati derecede önemlidir. Kalp yetersizliği hastalarının tedavi ve bakımı, genel açıdan pek çok disiplinin bir arada çalışmasını zorunlu kılmaktadır. Bununla birlikte, ileri evre kalp yetersizliği hastaları; kardiyoloji uzmanları, kalp damar cerrahisi uzmanları ve bu hastaların bakımından sorumlu diğer tıbbi personel arasında çok yakın iletişim ve iş birliğini gerektirmesi nedeniyle, kılavuz önerileri doğrultusunda, "kalp ekibi" tarafından ele alınmalıdır. Ülkemiz, ileri evre kalp yetersizliğinin yönetimi konusunda deneyim sahibi hekimlere sahiptir. Ancak, merkezlerin dağılımı, hastaların tedavi seçeneğine eşit derecede ulaşımı konularında yeterli olduğumuz söylenemez. Bu nedenle, uygun aday hastanın sevki ve hasta dolaşımı konularında daha kat edecek yolumuz bulunmaktadır. Bu uzlaşı raporu; ileri evre kalp yetersizliği yönetiminde deneyimli ve sertifikasyona sahip merkezler ile evresinden bağımsız olarak kalp yetersizliği hastalarının takip ve tedavisinin düzenlendiği merkezler ve diğer sağlık personeli arasındaki bağı güçlendirmek, farkındalığı artırmak ve ülkemiz koşullarına ilişkin güncel bilgi sağlamak amacıyla hazırlanmıştır., Heart failure is a progressive disease. A considerable portion of patients reach an advanced or terminal phase later or sooner, despite all of the developments in diagnosis, management, and follow-up and alternatives which can slow the disease process. As well as the palliative care of the patient in the terminal phase, definite recognition of the patient with advanced disease is vital for the consideration of therapeutic options in this patient population. Overall management and care of patients with heart failure obligates a collaboration of multiple disciplines. In addition, patients with advanced heart failure should be managed by a "heart team", as indicated by the guideline recommendations, since it requires a close communication and collaboration among cardiologists, cardiovascular surgeons, and other medical staff who are responsible for taking care of these patients. In Turkey, we have experienced physicians for managing patients with advanced heart failure. However, we are unlikely to be sufficient in the distribution of the centers and equal accessibility for all patients to therapeutic options. Hence, we still have more to do for the referral of eligible patients and patient circulation issues. This consensus report is developed to strengthen the connection between experienced and certified centers and the centers which take care of heart failure patients independent of the disease phase and other healthcare staff to increase awareness and to provide updated information for the current conditions of Turkey.

Myocardial ischemia-reperfusion injury may complicate coronary artery bypass grafting (CABG) operations. N-Acetylcysteine (NAC) had antioxidant and microcirculatory effects, and inhibits neutrophil aggregation. The aim of this study was to determine the effects of NAC in limiting myocardial ischemia-reperfusion injury in CABG operations. Twenty patients undergoing elective coronary bypass operation with cardiopulmonary bypass were enrolled and randomly assigned to two groups: a control group operated with a routine CABG protocol, and one where NAC was administered intravenously during the operation (NAC group). Blood samples from coronary sinus for tumor necrosis factor-alpha assay, myocardial biopsy specimens for chemiluminescent luminol, and lucigenin measurements of reactive oxygen species were taken. The luminol (specific for (*)OH, H(2)O(2), and HOCl(-) radicals) and lucigenin (specific for O(2) (*-)) levels and the difference ratios after reperfusion were significantly lower in the NAC group. Tumor necrosis factor-alpha levels increased in the control group but, in contrast, a significant decrease was detected in the NAC group (P < 0.01). Creatine kinase-MB levels at 6 and 12 hours were significantly lower in the NAC group (P = 0.02). N-Acetylcysteine has potential effects to limit ischemia reperfusion injury during CABG operations. We believe that its effects on clinical outcome may be more apparent in patients prone to ischemia-reperfusion injury.

Background: The hemodynamically efficient valves with effective orifice areas that are used in aortic valve replacement have been positively determined to affect postoperative exercise capacity. The aim of this study was to evaluate the functional effects of aortic root enlargement in the late postoperative period for patients with a small effective orifice area. Methods: Nineteen patients with a small effective orifice area were included in the study. The study group comprised 9 patients who underwent isolated aortic valve replacement with 23-mm St. Jude Medical prosthetic valves and posterior aortic root enlargement. The control group comprised 10 patients in whom 19-mm and 21-mm St. Jude Medical prosthetic valves were implanted without aortic root enlargement. The patients were evaluated in the late postoperative period with echocardiography and cardiopulmonary exercise testing. Results: The 2 groups were similar in anthropometric parameter values, follow-up periods, echocardiographic findings, and the gradients at the prosthetic aortic valve at rest; however, the anaerobic threshold, peak oxygen uptake, minute ventilation volume, and walk time were significantly higher in the study group (P < .05). Conclusion: The choice of aortic root enlargement for the implantation of a valve with a larger effective orifice area is preferred by most of the surgeons over the implantation of a valve with a smaller effective orifice area. The late postoperative functional capacity of the patient is significantly improved with root enlargement. Surgeons should be encouraged to perform root enlargement in patients with a small effective orifice area, and such surgery may even be performed routinely in these patients.

Objectives: Obesity is a major public health problem with an increasing prevalence. Although coronary artery bypass grafting (CABG) operations are now performed with low morbidity and mortality rates, obesity is still assumed to be an important risk factor for morbidity and mortality at these operations but there is no precise approach to define it as a risk factor. The aim of this study is to evaluate the effects of obesity on the clinical outcome of the CABG operations. Methods: A total of 1206 patients, who underwent isolated CABG operation under cardiopulmonary bypass were evaluated retrospectively. The patients were divided into three groups. Group I was normal weight, with body mass index (BMI) of 18 – 24.9 kg/m 2 , group II was overweight, with a BMI of 25– 29.9 kg/m 2 , and group III was obese, with a BMI of . 30 kg/m 2 . The clinical data of three groups were evaluated in aspects of postoperative morbidity and mortality. Results: Except for the superficial wound infections, there were no differences in postoperative mortality and morbidity rates between the three groups. Obesity was not found to be an important risk factor for postoperative morbidity and mortality. Conclusions: Despite the perception that obesity increases the risk of mortality and morbidity in CABG operations, the clinical outcome of these patients are not so different from other patients. We may say that obese patients can be safely operated. q 2003 Elsevier B.V. All rights reserved.

Article history: Received 7 October 2015 Accepted 17 October 2015 Available online 17 October 2015 levosimendan and dobutamine only temporarily reduced his symptoms. Since his symptoms were unresponsive to medical treatment, he was considered as a potential candidate for LVAD implantation or heart transplantation. On cardiac catheterization, his PAP was 70/ 40 mmHg (mean 50 mmHg), right atrial (RA) pressure was 15 mmHg, and his PVR and right ventricular stroke work index (RVSWI) were calculated as 6Wood Units and 332 mmHg·ml/m, respectively (Table 1).

The Current Status of Heart Transplantation and Mechanical Circulatory Support in Turkey: Facts and Factors M. Sargin ,1 G. Orhan,1 S.A. Aka,1 M.E. Mete,1 R. Akar,2 M.A. Ozatik,3 C. Engin,4 M. Balkanay,5 B. Omer.6 1Cardiovascular Surgery, Siyami Ersek Hospital, Istanbul, Turkey; 2Cardiovascular Surgery, Ankara University, Ankara, Turkey; 3Heart Transplantation Council, Ministry of Health, Ankara, Turkey; 4Cardiovascular Surgery, Ege University, Istanbul, Turkey; 5Cardiovascular Surgery, Izmir Ataturk EAH, Istanbul, Turkey; 6Cardiovascular Surgery, Akdeniz University, Antalya, Turkey.

Increased coronary artery disease (CAD) risk is well established in diabetes mellitus (DM). Paraoxonase (PON) enzyme is known to have protective effects on lipid peroxidation. This study aimed to investigate the changes in PON activity levels with duration of DM as well as the role of PON activity in progression of CAD. Eighty-four consecutive diabetic patients (mean age 58 years, 46 men) who underwent coronary angiography for diagnostic purposes were examined. Before the angiography, fasting venous blood samples were taken for PON enzyme activity, thiobarbituric acid reactive substances (TBARS), and routine biochemical parameters. Severity and extent of coronary atherosclerosis were scored numerically using the Gensini scoring system. The population was divided into three groups according to Gensini score: Group 1, mild CAD; Group 2, moderate CAD; Group 3, severe CAD. Group 1 had higher PON levels and shorter DM duration than those of Group 3. Gensini score was significantly correlated with, PON activity (r = −0.361) and apo-AI (r = −0.375). TBARS (r = −0.290) and the duration of DM (r = −0.336) also showed a significant correlation with PON activity levels. Also, multivariate linear regression and Pearson correlation analyses showed that PON activity (P = 0.04), apo-AI levels (P = 0.01), and the duration of DM (P = 0.003) were significantly associated with Gensini score. Paraoxonase activity decreases parallel to DM duration. The lack of protective effect of PON enzyme on lipid peroxidation may be a factor in acceleration of CAD in DM.

Background The renin-angiotensin system has a very important role in coronary thrombosis and restenosis. Plasma angiotensin converting enzyme (ACE) activity is associated with an insertion/deletion polymorphism in the gene coding for ACE. It is known that there is a strong correlation between ACE DD and atherosclerosis. However, little has been documented about its role in venous graft failure. The objective of this study was to investigate the relationships among the ACE gen polymorphism and long-term vein graft occlusion. Methods The study population consisted of 87 consecutive white patients with symptomatic coronary artery disease in the previous month, who had had aorto-coronary bypass surgery (ACBS) more than 5 years back and who underwent coronary angiography for diagnostic purposes. On the same day of angiography, 10 mL whole blood was taken for ACE gene insertion/deletion (I/D) polymorphism. Results Mean age of the patients was 64.4 +/- 8.6 years, and 71 (82%) of the patients were men. The average ACBS time was 7.9 +/- 1.9 years. The ACE genotype was II in 15 patients (17.2%), ID in 47 patients (54.0%), and DD in 25 patients (28.7%). Thus, D allele frequency was .82. There was no significant difference between the cases with regard to age, body mass index, blood pressure status, plasma glucose level, plasma lipid profile, smoking status, average of ACBS time or family history of coronary heart disease. In ACE II group 5 patients had total venous graft occlusion, in ACE ID group 27 patients had total occlusion and in ACE DD group 20 patients had at least one graft total occlusion. The frequency of the venous graft occlusion about total venous grafts is 36% in the ACE II group, 49% in the ACE ID group, and 80% in the ACE DD group (P = .01). Conclusion The ACE I/D gene polymorphism is associated with long-term survival of venous conduit. The ACE DD genotype or D allele influences the angiographic outcome of patients post-ACBS. These data suggest that routine determination of the ACE genotype may help identify patients who are at higher risk of venous graft failure after ACBS.

From November 1987 to May 1998, 16 patients with a small aortic annulus underwent patch enlargement of the aortic valve by Nicks' technique (in 9) or Manouguian's method (in 7). The mean age of the patients was 40 years (range, 22 to 58 years), mean body surface area was 1.54 m2 (range, 0.95 to 2.05 m2), and 11 were female. Concomitant procedures were mitral valve replacement in 4 cases, tricuspid commissurotomy and De Vega annuloplasty in 2, and one case each of patent ductus arteriosus ligation and coronary bypass. Aortic annular sizes were 15 to 19 mm (mean, 17.4 mm) preoperatively and 20 to 24 mm (mean, 22.1 mm) after the procedure. Two patients (12.5%) died in the early postoperative period. Peak pressure gradients across the prostheses were 15 to 22 mm Hg (mean, 19.4 mm Hg) on echocardiography. The mean duration of follow-up was 32.85 months (3 months to 8 years) and it was 92.8% complete. There were no late deaths. Mitral valve function was good except in one patient who had minimal mitral regurgitation after Manouguian's procedure. Both methods were found to be effective and reliable and should be performed when there is a risk of patient-prosthesis mismatch.

Background. The aims of this study were to elucidate the incidence of mitral regurgitation during off-pump coronary artery bypass (OPCAB) surgery to evaluate the relationship of the changes with ventricular function and possible mitral valve regurgitation caused by positioning. Methods. Included in the study were 60 consecutive patients who underwent CAB grafting on the beating heart. We monitored several hemodynamic variables (systolic arterial pressure, mean arterial pressure, right atrial pressure, pulmonary capillary wedge pressure, and heart rate) at baseline and after each anastomosis and used transesophageal echocardiography (TEE) routinely after sternotomy, during each anastomosis, and after completion of the operation. Valvular functions, ejection fraction, and wall motion systolic index were recorded during each TEE evaluation. Results. All of the patients underwent complete revascularization. We performed 132 consecutive OPCAB anastomoses in 60 patients (60 left anterior descending artery [LAD], 20 right coronary artery [RCA], 45 left circumflex coronary artery [LCX], and 7 diagonal artery grafts). During LCX anastomosis, 38 (84.4%) of 45 patients developed moderate mitral regurgitation. The wall motion score index (WMSI) significantly increased during CX grafting, as was demonstrated by higher WMSI values than for the RCA, diagonal, and LAD grafts. The ejection fraction was decreased significantly during CX and RCA anastomoses compared with baseline levels. The hemodynamic changes were in accord with these findings. The greatest hemodynamic compromise was seen during CX anastomosis. Conclusion. Positional mitral regurgitation occurs frequently and is a major contributor to hemodynamic instability during posterior- and lateral-wall revascularization during the OPCAB procedure.