Browsing by Author "Sezgin, Atilla"

Now showing 1 - 20 of 67

Acute Renal Failure and Its Impact on Survival Following Cardiac Transplantation
(2016) Sezer, Siren; Yavuz, Demet; Canoz, Mujdat Batur; Altunoglu, Alparslan; Sezgin, Atilla; Arat, Zubeyde; Ozdemir Acar, Fatma Nurhan; Haberal, Mehmet; 0000-0002-4082-6320; 0000-0002-3462-7632; ABG-9980-2021; AAJ-8097-2021
OBJECTIVE: We evaluated the incidence and risk factors for acute renal failure (ARF) and also the associated hazard of death in recipients of cardiac transplants. MATERIAL and MET HODS: We included 25 patients in the study; 18 patients developed ARF (72%) and underwent continuous venovenous hemodiafiltration (Group I) and 7 patients had stable renal function (28%) (Group II). We retrospectively retrieved demographic variables; clinical, perioperative, postoperative complications and echocardiographic data; and biochemical parameters at the time of the surgery and six months later. RESULTS: Cumulative survival was 72.2% after 6 months, 64.2% after 24 months, and 51.4% after 32 months for Group I and 50% after 32 months for Group II (p> 0.05). A total of 8 patients died (32%); 1 (5.5%) from Group I and 7 (87.5%) from Group II. Risk factors for ARF were preoperative serum BUN, creatinine levels, and cardiopulmonary bypass time (p< 0.05). Only one patient underwent chronic hemodialysis because of chronic renal dysfunction in Group I while there was no such patient in group II. CONCLUSION: Preoperative serum BUN, creatinine value, and cardioopulmonary bypass time were found to be risk factors for ARF after cardiac transplantation. Postoperative renal dysfunction did not affect long-term renal function and survival.
Acute Respiratory Failure in Cardiac Transplant Recipients
(2015) Komurcu, Ozgur; Ozdemirkan, Aycan; Firat, Aynur Camkiran; Zeyneloglu, Pinar; Sezgin, Atilla; Pirat, Arash; 0000-0003-2312-9942; 0000-0003-1470-7501; 26640904; C-3736-2018; AAH-7003-2019
Objectives: This study sought to evaluate the incidence, risk factors, and outcomes of acute respiratory failure in cardiac transplant recipients. Materials and Methods: Cardiac transplant recipients >15 years of age and readmitted to the intensive care unit after cardiac transplant between 2005 and 2015 were included. Results: Thirty-nine patients were included in the final analyses. Patients with acute respiratory failure and without acute respiratory failure were compared. The most frequent causes of readmission were routine intensive care unit follow-up after endomyocardial biopsy, heart failure, sepsis, and pneumonia. Patients who were readmitted to the intensive care unit were further divided into 2 groups based on presence of acute respiratory failure. Patients' ages and body weights did not differ between groups. The groups were not different in terms of comorbidities. The admission sequential organ failure assessment scores were higher in patients with acute respiratory failure. Patients with acute respiratory failure were more likely to use bronchodilators and n-acetylcysteine before readmission. Mean peak inspiratory pressures were higher in patients in acute respiratory failure. Patients with acute respiratory failure developed sepsis more frequently and they were more likely to have hypotension. Patients with acute respiratory failure had higher values of serum creatinine before admission to intensive care unit and in the first day of intensive care unit. Patients with acute respiratory failure had more frequent bilateral opacities on chest radiographs and positive blood and urine cultures. Duration of intensive care unit and hospital stays were not statistically different between groups. Mortality in patients with acute respiratory failure was 76.5% compared with 0% in patients without acute respiratory failure. Conclusions: A significant number of cardiac transplant recipients were readmitted to the intensive care unit. Patients presenting with acute respiratory failure on readmission more frequently developed sepsis and hypotension, suggesting a poorer prognosis.
Approach To Optimal Assessment Of Right Ventricular Remodelling In Heart Transplant Recipients: Insights From Myocardial Work Index, T1 Mapping, And Endomyocardial Biopsy
(2023) Colak, Ayse; Duzgun, Selin Ardali; Hazirolan, Tuncay; Sezgin, Atilla; Donal, Erwan; Butcher, Steele C.; Ozdemir, Handan; Pirat, Bahar; Eroglu, Serpil; Muderrisoglu, Haldun; Sade, Leyla Elif; https://orcid.org/0000-0002-7528-3557; https://orcid.org/0000-0003-3737-8595; 35666833; X-8540-2019; AAQ-7583-2021
Aims Right ventricular (RV) dysfunction is an important cause of graft failure after heart transplantation (HTx). We sought to investigate relative merits of echocardiographic tools and cardiac magnetic resonance (CMR) with T1 mapping for the assessment of functional adaptation and remodelling of the RV in HTx recipients. Methods and results Sixty-one complete data set of echocardiography, CMR, right heart catheterization, and biopsy were obtained. Myocardial work index (MWI) was quantified by integrating longitudinal strain (LS) with invasively measured pulmonary artery pressure. CMR derived RV volumes, T1 time, and extracellular volume (ECV) were quantified. Endomyocardial biopsy findings were used as the reference standard for myocardial microstructural changes. In HTx recipients who never had a previous allograft rejection, longitudinal function parameters were lower than healthy organ donors, while ejection fraction (EF) (52.0 +/- 8.7%) and MWI (403.2 +/- 77.2 mmHg%) were preserved. Rejection was characterized by significantly reduced LS, MWI, longer T1 time, and increased ECV that improved after recovery, whereas RV volumes and EF did not change MWI was the strongest determinant of rejection related myocardial damage (area under curve: 0.812, P < 0.0001, 95% CI: 0.69-0.94) with good specificity (77%), albeit modest sensitivity. In contrast, T1 time and ECV were sensitive (84%, both) but not specific to detect subclinical RV damage. Conclusion Subclinical adaptive RV remodelling is characterized by preserved RV EF despite longitudinal function abnormalities, except for MWI. While ultrastructural damage is reflected by MWI, ECV, and T1 time, only MWI has the capability to discriminate functional adaptation from transition to subclinical structural damage.
Cardiovascular Surgeon's Perspective of the Iatrogenic Vascular Injuries in Gynecologic Surgery
(2014) Akay, Hakki Tankut; Korun, Oktay; Sezgin, Atilla; Aslamaci, Sait; https://orcid.org/0000-0002-5776-6993; AAJ-1341-2020
Background: This study aims to define basic parameters and to propose certain attitudes towards the management of such patients. Methods: Data of the 18 gynecologic surgery patients (mean age 54.4 +/- 3.2 years; range 45 to 63 years) who were intraoperatively consulted to vascular surgery for vascular trauma between January 2003 and December 2012 were retrospectively analyzed. All patients had undergone a previous surgical procedure in the same surgical site. Results: The vascular structures injured were the iliac arteries in eight patients, iliac veins in eight patients and inferior vena cava in two patients. The mean length of intensive care unit and hospital stays were 2.7 +/- 1.2 and 7.1 +/- 1.6 days, respectively. One patient died postoperatively. Conclusion: We believe that favorable results for this potentially lethal complication can be achieved with individual management strategies tailored in accordance with certain principles.
A case of primer angiosarcoma in a young woman: lessons from multi-modality imaging
(2022) Coskun, Mehmet; Hasirci, Senem Has; Ozdemir, Handan; Coskun, Mehmet; Sezgin, Atilla; Muderrisoglu, I. Haldun; Sade, Leyla Elif; 0000-0002-7528-3557; X-8540-2019
CLINICAL CHARACTERISTICS AND OUTCOME OF HERPES ZOSTER IN SOLID ORGAN TRANSPLANT PATIENTS: A SINGLE CENTER CASE SERIES
(2020) Altunel, Cemile Tugba; Seckin, Deniz; Sayin, Burak; Sezgin, Atilla; Akdur, Aydincan; Haberal, Mehmet A.
COMPARISON OF PURE ANTIBODY-MEDIATED REJECTION (AMR) WITH MIXED CELLULAR AND AMR IN REGARDS TO THE DEVELOPMENT OF CARDIAC ALLOGRAFT VASCULOPATHY (CAV) AND CARDIOVASCULAR MORTALITY (CVM) IN HEART TRANSPLANT PATIENTS
(2019) Ozdemir, B. Handan; Ayva, Sebnem; Terzi, Aysen; Sade, L. Elif; Basturk, Bilkay; Sezgin, Atilla
COMPARISON OF PURE ANTIBODY-MEDIATED REJECTION WITH MIXED CELLULAR AND ANTIBODY-MEDIATED REJECTION IN REGARDS TO THE PATHOLOGICAL FEATURES, DEVELOPMENT OF CARDIAC ALLOGRAFT VASCULOPATHY (CAV) AND CARDIOVASCULAR MORTALITY (CVM) IN HEART TRANSPLANT PATIENTS
(2020) Ozdemir, B. Handan; Terzi, Aysen; Ayva, Sebnem; Sade, L. Elif; Basturk, Bilkay; Sezgin, Atilla
A Comparison of Two Coronary Artery Bypass Graft Surgery Techniques with Respect to Acute Kidney Injury
(2015) Beyazpinar, Deniz Sarp; Gultekin, Bahadir; Kayipmaz, Afsin Emre; Kayipmaz, Cagri; Sezgin, Atilla; Giray, Tufan Akin; Kavalci, Cemil; 0000-0003-2529-2946; 0000-0003-4619-4034; AAC-2597-2020; AGG-1308-2022; ABA-7388-2021; ABA-9675-2021; AGQ-5015-2022
Background: This study aims to compare the conventional coronary artery bypass graft (CABG) surgery and on-pump beating heart bypass grafting (OPBHB) with respect to acute kidney injury and subsequent dialysis requirement. Methods: Between January 2012 and October 2013, medical records of 77 patients who underwent conventional CABG and 76 patients who underwent OPBHB for coronary artery disease in our clinic were retrospectively analyzed. Results: There was no significant difference in preoperative renal function test results between the groups. However, there was a significant difference in cardiopulmonary bypass time and length of intensive care unit stay (p<0.05). Seven (9.21%) of 76 patients in OPBHB group and 11 (14.28%) of 77 patients in CABG group developed acute kidney injury; however, it did not indicate a statistically significant difference between the groups (p>0.05). One patient in OPBHB group and four patients in CABG group also needed dialysis. Conclusion: Our study results suggest that OPBHB is superior to the conventional CABG in terms of acute kidney injury and, more importantly, development of acute renal failure in patients with a serum creatinine level of 1-1.3 mg/dL.
Decompression of Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Support as a Step to Transplant
(2016) Gultekin, Bahadir; Ersoy, Ozgur; Akkaya, Ilknur; Kayipmaz, Cagri; Pirat, Aras; Sezgin, Atilla; 27805509; ABA-7388-2021
Objectives: Left ventricular distention can be recognized during the use of venoarterial extracorporeal membrane oxygenation as a key complication. Left ventricular decompression may decrease pulmonary pressure, minimize ventricular distention, and allow myocardial recovery. Materials and Methods: We applied venoarterial extracorporeal membrane oxygenation to 4 patients while on a wait list for cardiac transplant. Results: Two patients with severe heart failure developed high end-diastolic pressures leading to left ventricular distention. We used atrial venting methods to decrease the pressure. Conclusions: Here, we discussed the strategies to manage ventricular distention by conservative, interventional, and surgical means.
Detection of Donor-Specific Antibodies Both in Serum and Cardiac Allograft Biopsy in Heart Transplant Patients: Tissue DSA is More Predictive than Serum DSA
(2018) Basturk, Bilkay; Sezgin, Atilla; Sade, Elif; Ozdemir, B. Handan; Terzi, Aysen; Kantaroglu, Bircan; Haberal, Mehmet; 0000-0002-8784-1974; 0000-0002-7528-3557; 0000-0002-1225-1320; 0000-0002-3462-7632; AAD-6918-2021; X-8540-2019; F-7546-2013; AAJ-8097-2021
Determination of Cytokine Gene Polymorphisms in a Heart Transplant Patient Resistant to Desensitization Therapy: Case Report
(2022) Basturk, Bilkay; Kavuzlu, Miray; Khalilova, Afag; Kantaroglu, Bircan; Sezgin, Atilla; https://orcid.org/0000-0002-9288-942X; 35384819; AAE-2689-2021
Heart transplant is the best treatment option for end-stage heart failure. The major goals in solid-organ transplant are organ survivability and functionality. The effects of anti-HLA antibodies and cytokines are important for immune response. Cytokine gene polymorphisms are also effective during cytokine release. Here, we report a heart transplant recipient who was diagnosed with antibody-mediated rejection posttransplant and had an antibody response resistant to desensitization therapy. After transplant, panel reactive antibody screening and identification class I and II tests and Luminex single antigen class I and II tests were performed. Desensitization treatment included intravenous immunoglobulin, plasmapheresis, rituximab, and bortezomib. Because of these reasons, cytokine gene polymorphism tests (consistent with low, intermediate, and high expression levels for tumor necrosis factor a, transforming growth factor ss 1, interleukin 6 and 10, and interferon.) were conducted. We found polymorphic regions compatible with the high-release, proinflammatory action of tumor necrosis factor a and interleukin 6, which induced inflammation and B-cell activation, and polymorphic regions compatible with the intermediate release of the potent immunosuppres- sive effects of transforming growth factor ss 1 and interleukin 10, suggesting that the patient may not be able to effectively suppress the activation of the immune system. The influence of cytokine gene polymorphism on the formation of a resistant antibody response in a patient, despite desensitization, contributed to the proinflammatory response in which these cytokines were involved.
Distal Limb Reperfusion During Percutaneous Femoral Arterial Cannulation for Veno-Arterial Extracorporeal Membrane Oxygenation in an Adult Patient
(2019) Firat, Aynur Camkiran; Sezgin, Atilla; Pirat, Arash; 31276115
Ischemia and compartment syndrome may be seen, especially in the distal limb, after femora-femoral cannulation for extracorporeal membrane oxygenation (ECMO). Several techniques have been used to decrease the rate of complications. Arterial hypoxemia may be prevented by reperfusion with distal limb. Prophylactic superficial femoral artery cannulation results in ease in operation and prevents perfusion. In the present case, we present prophylactic superficial femoral artery cannulation for limb reperfusion.
Early Bloodstream Infections Among Solid Organ Transplant Recipients
(2016) Yesilkaya, Aysegul; Soy, Ebru; Ok, Mehtap Akcil; Azap, Ozlem Kurt; Arslan, Hande; Moray, Gokhan; Sezgin, Atilla; Berdan, Fatos; Haberal, Mehmet; https://orcid.org/0000-0002-0993-9917; https://orcid.org/0000-0002-3171-8926; https://orcid.org/0000-0002-5708-7915; https://orcid.org/0000-0003-2498-7287; https://orcid.org/0000-0002-3462-7632; AAC-5566-2019; AAZ-8170-2020; AAK-4089-2021; ABG-7034-2021; AAE-1041-2021; AAJ-8097-2021
Early Postoperative Acute Kidney Injury Among Heart Transplant Recipients: Incidence, Risk Factors and Impact on Clinical Consequences
(2018) Aliyev, Ali; Ayhan, Asude; Zeyneloglu, Pinar; Pirat, Arash; Sezgin, Atilla; Kayhan, Zeynep; 000-0003-3299-6706; 0000-0003-0579-1115; AAE-8052-2019; AAJ-2066-2021; AAJ-4623-2021
Effect of Left Ventricular Assist Devices on Red Blood Cell Distribution Width
(2015) Ersoy, Ozgur; Gultekin, Bahadir; Ozkan, Murat; Akkaya, Ilknur; Umaroglu, Sevi; Sezgin, Atilla; 26640934; ABA-7388-2021
Objectives: Red blood cell distribution width is a measure of the variability in the size of circulating erythrocytes, which is calculated by automated blood cell counters as part of a routine blood cell count analysis. Our aim was to examine whether continuous flow left ventricular assist devices affected red blood cell distribution width. Materials and Methods: Our study included 16 of 24 patients who received a HeartWare HVAD Pump (HeartWare Inc, Framingham, MA, USA) implant (continuous flow left ventricular assist device) between April 2012 and February 2015 at our institution. The mean age of the patients was 46.6 years. We compared patient erythrocyte, leucocyte, and platelet counts, hemoglobin and hematocrit levels, mean corpuscular volume, and red blood cell distribution width values before and 6 months after implant. Results: Hemoglobin level (P=.008), hematocrit level (P=.027), and mean corpuscular volume (P=.003) were significantly decreased; however, we observed no significant change in red blood cell distribution width. Conclusions: Although we did not find significant results in our group of patients with left ventricular assist device implant, a larger group of patients may show more significant results, and an increase in red blood cell distribution width can be used as an indicator of a negative prognosis in these patients.
The Effect of Positive End Expiratory Pressure on Right Ventricular Functions in Coronary Artery Bypass Graft Surgery
(2017) Turker, Melis; Firat, Aynur Camkiran; Pirat, Bahar; Sezgin, Atilla; Pirat, Arash; https://orcid.org/0000-0003-4576-8630; AAI-8897-2021
Background: This study aims to investigate the effect of positive end-expiratory pressure on the right ventricular functions by speckle tracking method in patients undergoing coronary artery bypass grafting. Methods: This prospective study included a total of 20 patients (17 males, 3 females; mean age 59.7 +/- 10.5 years; range 42 to 77 years) who underwent coronary artery bypass grafting between May 2013 and September 2013. After initiation of 5 cmH(2)O positive end-expiratory pressure during mechanical ventilation before sternotomy, 10 and 20 cmH(2)O of positive end-expiratory pressure were applied in five-min intervals, respectively. Four-chamber and two-chamber views of the right ventricle were recorded at each pressure level using transesophageal echocardiography. The right ventricle diameter and velocity, longitudinal strain and strain rate, and right ventricle fractional area change were calculated. Results: Intraoperative systolic, diastolic, and mean blood pressures and mean heart rate were similar at the three positive end-expiratory pressure levels. The mean right ventricle strain value was significantly lower at 20 cmH(2)O pressure (p<0.001 for both). The mean strain rate was significantly lower at 20 cmH(2)O pressure, compared to 5 cmH(2)O pressure (p=0.03). The right ventricle velocity was found to significantly decreased with increasing positive end-expiratory pressure (p<0.05). The mean right ventricle fractional area change was similar at 5 and 10 cmH(2)O pressures (p=0.063), while it was significantly lower at 20 cmH(2)O pressure (p=0.001). The mean right ventricle diameter decreased with increasing positive end-expiratory pressure, while this decrease was significant at 20 cmH(2)O pressure (p=0.01). Conclusion: Our study results show that 5, 10, and 20 cmH(2)O positive end-expiratory pressures does not significantly change hemodynamic data in patients undergoing coronary artery bypass grafting with normal right ventricular functions; however, 20 cmH(2)O positive end-expiratory pressure leads to decreased right ventricular functions, as assessed by transesophageal echocardiography.
The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement
(2014) Bal, Ugur; Aydinalp, Alp; Yilmaz, Kerem; Ozcalik, Emre; Hasirci, Senem; Atar, Ilyas; Gultekin, Bahadir; Sezgin, Atilla; Muderrisoglu, Haldun
Background: Mechanical heart valve replacement has an inherent risk of thromboembolic events (TEs). Current guidelines recommend an international normalized ratio (INR) of at least 2.5 after mechanical mitral valve replacement (MVR). This study aimed to evaluate the effects of a low INR (2.0-2.5) on thromboembolic and bleeding complications in patients with mechanical MVR on warfarin therapy. Methods: One hundred and thirty-five patients who underwent mechanical MVR were enrolled in this study. The end points of this study were defined as TEs (valve thrombosis, transient ischemic attack, stroke) and bleeding (all minor and major bleeding) complications. Patients were followed up for a mean of 39.6 months and the mean INR of the patients was calculated. After data collection, patients were divided into 3 groups according to their mean INR, as follows: group 1 (n = 34), INR < 2.0; group 2 (n = 49), INR 2.0-2.5; and group 3 (n = 52), INR > 2.5. Results: A total of 22 events (10 [7.4%] thromboembolic and 12 [8.8%] bleeding events) occurred in the follow-up period. The mean INR was an independent risk factor for the development of TEs. Mean INR and neurological dysfunction were independent risk factors for the development of bleeding events. A statistically significant positive correlation was found between the log mean INR and all bleeding events, and a negative correlation was found between the log mean INR and all TEs. The total number of events was significantly lower in group 2 than in groups 1 and 3 (P = 0.036). Conclusions: This study showed that a target INRs of 2.0-2.5 are acceptable for preventing TEs and safe in terms of bleeding complications in patients with mechanical MVR.
Evaluation of Acute Rejection by Measuring Strain and Strain Rate in Children With Heart Transplant: A Preliminary Report
(2017) Gursu, Hazim Alper; Varan, Birgul; Sade, Elif; Erdogan, Ilkay; Sezgin, Atilla; Aslamaci, Sait; 0000-0002-0707-2678; 0000-0002-6719-8563; 0000-0001-6887-3033; 27310367; AHI-4502-2022; ABB-1767-2021; ABB-2220-2021
Objectives: Asymptomatic rejection after heart transplant is difficult to detect by noninvasive methods. The present study investigated the efficacy of echocardiographic strain and the strain rate imaging method in detecting rejection after pediatric heart transplant. Materials and Methods: Fourteen pediatric patients with heart transplant were examined both with endomyocardial biopsy and strain imaging. Patients were divided into 2 groups: group 1 included patients with rejection, and group 2 included patients without rejection. Patients underwent endomyocardial biopsy at regular intervals. Regional systolic function was evaluated by longitudinal myocardial peak systolic values of strain and of strain rate. Differences between the 2 groups were assessed with unpaired t test or Mann-Whitney U test. Results: Acute rejection was detected in 7 patients (4 were female patients). Cardiac diagnosis was restrictive cardiomyopathy in 3 patients, dilated cardiomyopathy in 3 patients, and complex congenital heart disease in 1 patient. After heart transplant, 6 patients had rejection once and 1 patient had rejection twice. Evaluation of biopsy samples revealed grade IB rejection in all patients in group 1. Systolic functions of the 6 patients were determined as normal in standard echocardiographic examination. There were no significant differences in deformation and deformation rates between group 1 and 2 except in midseptal region (P<.05). Conclusions: One of the most significant complications in patients with heart transplant is rejection. Our results suggested that myocardial strain imaging may be valuable in defining low-grade rejection.
Evaluation of Neuroimaging Findings of Central Nervous System Complications in Heart Transplant Recipients
(2020) Turnaoglu, Hale; Agildere, Ahmet Muhtesem; Rahatli, Feride Kural; Donmez, FuldemYildirim; Ocal, Ruhsen; Sezer, Taner; Can, Ufuk; Sezgin, Atilla; Aslamaci, Sait; 0000-0002-2278-1827; 0000-0001-8689-417X; 0000-0003-4223-7017; 29790456; AAJ-5931-2021; AAJ-2999-2021; AAB-5802-2020
Objectives: In this study, we presented neuroradiologic findings and diagnoses of neurologic complications in a series of heart transplant recipients. Materials and Methods: A retrospective review was conducted at Baskent University Hospital. We searched the hospital and radiology databases and identified 109 heart transplant recipients. Thirty-one of these recipients had neuroradiologic evaluations secondary to presentation of neurologic symptoms after heart transplant, with 18 patients evaluated with computed tomography and 22 patients evaluated with magnetic resonance imaging (overlap of imaging-defined groups occurred in 9 recipients). Computed tomography and magnetic resonance imaging studies were retrieved from the Picture Archiving and Communication System, with each type of imaging retrospectively evaluated on consensus by 2 radiologists. Results: Radiopathologic findings related to symptoms were detected in 12 of the 31 study patients. The most common abnormality was posterior reversible leuko-encephalopathy syndrome (5 patients, 4.6%). The other abnormalities were ischemic stroke (3 patients, 2.8%), hemorrhagic stroke (1 patient, 0.9%), intracranial abscess (2 patients, 1.8%), and intracranial dissemination of sinusoidal fungal infection and related hemorrhagic infarct (1 patient, 0.9%). The other 19 heart transplant recipients who underwent computed tomography and/or magnetic resonance imaging for neurologic complaints showed no neuroradiologic findings related to neurologic symptoms. Conclusions: Posterior reversible leukoencephalopathy syndrome and ischemic stroke were the most common neurologic complications in our heart transplant recipients. The other complications were hemorrhagic stroke, intracranial abscess, and intracranial dissemination of sinusoidal fungal infection. Neurologic complications are common in heart transplant recipients and should be identified promptly for early treatment. For the recognition of these complications, computed tomography should be performed for initial evaluation to rule out edema or hemorrhage. However, in the presence of serious neurologic symptoms that cannot be explained by computed tomography, magnetic resonance imaging should be indicated.