Scopus İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4809
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Item Double Layer Reconstruction of Exposed Cardiac Implantable Electronic Devices in Elderly Patients(2021) Ozkan, Burak; Albayati, Abbas; Yilmaz, Kerem C.; Ciftci, Orcun; Ozin, Bulent; Uysal, Cagri A.; Ertas, Nilgun Markal; 0000-0001-8926-9142; 33542888; AAJ-1331-2021; W-5233-2018Background Elderly patients with multiple comorbidities may not be candidates for cardiac implanted electronic device (CIED) explantation in cases of exposition. Excision of all unhealthy and inflamed scar tissue results in a skin defect that must be covered. Small- to moderate-sized local skin flaps and subpectoral placement of CIEDs have been described in the literature. However, these techniques still could not eliminate the risk of recurrence. In terms of minimizing the recurrence risk, we aim to increase the flap dimensions for getting better circulation and tension-free closure after subpectoral placement. Material and methods Six patients who were operated for a dual-layer reconstruction of exposed cardiac implants between 2017 and 2020 were included in the study. All patients were referred to plastic surgery as soon as the wound biopsy culture results were negative after systemic and topical antibiotic treatment by cardiology department. Results No flap loss or wound dehiscence was seen with a mean duration of 11 months follow-up. Early hematoma was encountered in a patient who was managed with irrigation and drain renewal. One patient developed suture abscess in the second month postoperatively. Knots were removed and wound healed without further intervention. Conclusion Double layer closure of exposed cardiac implants with large breast fasciocutaneous flap after subpectoral placement of pulse generator and leads suggest durable and reliable coverage in elderly patients with multiple comorbidities.Item Acute Coronary Syndrome In Geriatric Patients In An Intensive Care Unit(2021) Keskin, Suzan; Akgun, Arzu Neslihan; Ciftci, Orcun; Muderrisoglu, Ibrahim HaldunObjective: The advancing age of acute coronary syndrome and the ageing population are leading to an increase in the number of elderly patients with acute coronary syndrome in our clinical practice. In our study, we aimed to investigate the effect of acute coronary syndrome in the geriatric patient group. Materials and Method: We retrospectively included geriatric patients who were in intensive care units because of different diagnoses, who also showed an acute coronary syndrome, and who had been diagnosed using the sequential organ failure assessment score. This score is used to describe the condition of a patient with sepsis and the extent of organ damage during treatment in an intensive care unit. We reviewed patients who were at Baskent University Faculty of Medicine between 25 March 2015 and 12 March 2020. Results: We included 63 patients aged 77.27 +/- 7.65 years. There were 40 (63.5%) males and 23 (36.5%) females. A total of 42 (89.4%) patients died in the first 5 months, one (2.1%) died between the 6th and 10th months, two (4.3%) between the 11th and 20th months, and two (4.3%) between the 21st and 30th months. We found a significant relationship between the sequential organ failure assessment score and mortality rate (p<0.05). The sequential organ failure assessment score was reliable in predicting mortality in geriatric patients with acute coronary syndrome, with 57% sensitivity and 75% specificity. Conclusion: Mortality of geriatric patients with acute coronary syndrome can be significantly determined using the sequential organ failure assessment scores.Item Prognostic value of MELD-XI score in patients referring to the emergency department with acute ST elevation myocardial infarction(2020) Celik, Olgun; Ciftci, Orcun; Mudderisoglu, Ibrahim Haldun; 0000-0001-8926-9142; 0000-0002-7190-5443; W-5233-2018; AAD-5477-2021Objective: We aimed to evaluate Model for End-stage Liver Disease excluding international normalized ratio (MELD-XI) score for prediction of 30-day in-hospital mortality in a cohort of patients with ST elevation myocardial infarction. Methods: The medical records of a total of 256 patients admitted with ST elevation myocardial infarction to the emergency department between January 2015 and January 2019 were retrospectively reviewed. A total of 111 patients were found eligible for the study. MELD-XI score was analyzed and compared on the basis of survival status. Results: A total of 111 patients with a mean age of 62.5 +/- 2.55 years were included in the study. In total, 81% (n = 90) of the patients were male and 19% (n = 21) were female. The mean MELD-XI score of the patients was 10.1 +/- 1.1. A total of 12 patients (12.9%) died within 30 days after hospitalization. The median MELD-XI score of the patients who died in the hospital was significantly higher than the patients survived (11.0 (10.5-11.6) vs 9.5 (9.4-13.8); p < 0.01). However, Gensini score was not significantly different between the surviving and deceased patients (p > 0.05). MELD-XI score was significantly correlated to left ventricular ejection fraction (r = -232, p < 0.01), and both parameters and age were significant independent predictors of in-hospital mortality (odds ratio: 1.73, 95% confidence interval: 1.25-2.39, p < 0.05; odds ratio: 0.89, 95% confidence interval: 0.81-0.99, p < 0.05; and odds ratio: 1.07, 95% confidence interval: 0.99-1.15, p < 0.05, respectively). A MELD-XI cut-off point of 10 had a sensitivity of 100% and a specificity of 78.8% for in-hospital mortality (area under receiver operating characteristics curve: 0.92, 95% confidence interval: 0.87-0.97, p < 0.05). A survival analysis based on a MELD-XI threshold of 10 revealed that the patients in the high-MELD-XI group had a significantly worse in-hospital survival (log rank test p < 0.001). Conclusion: MELD-XI score is a useful tool for in-hospital mortality prediction in patients referring to emergency medicine with acute ST elevation myocardial infarction.Item Markers of coagulation and fibrinolysis do not detect or predict the presence of left atrial appendage thrombus in patients with atrial fibrillation(2020) Doganozu, Ersin; Ciftci, Orcun; Hasirci, Senem; Yilmaz, Kerem Can; Karacaglar, Emir; Sade, Leyla Elif; Muderrisoglu, Ibrahim Haldun; Ozin, Mehmet Bulent; 0000-0002-2538-1642; 0000-0001-8926-9142; 0000-0002-8342-679X; 0000-0003-3737-8595; 32147650; ABI-6723-2020; W-5233-2018; AAK-7805-2021; AAJ-1331-2021; AAQ-7583-2021Objective: This study was designed to evaluate the role of hemostatic variables in arterial blood serum in left atrial thrombosis and to define any hemostatic variables, such as serum biomarkers, that could potentially reduce the need for transesophageal echocardiography. Method: This study included patients with non-valvular asymptomatic atrial fibrillation (AF), either paroxysmal, persistent, or chronic. The presence of an left atrial appendix (LAA) thrombus was used to form 2 groups: thrombus (+) and thrombus (-). The serum levels of the thrombotic/fibrinolytic markers including beta-thromboglobulin, prothrombin fragment 1+2, thrombin/antithrombin complex, human plasminogen activator inhibitor-1/tissue plasminogen activator complex, and D-dimer were compared between 2 groups. Results: The mean age of the study population was 65.6 +/- 12.2 years (range: 30-96 years), and 33 (61.1%) patients were male. Fourteen (25.9%) patients had an LAA thrombus and 40 patients did not. Two groups did not differ significantly with regard to any of the coagulation/fibrinolysis markers. The LAA thrombus (+) group had significantly higher rates of heart failure, peripheral artery disease, coronary artery disease, and chronic obstructive pulmonary disease (p<0.05). Neither the serum levels of the study markers nor demographic and clinical parameters were predictive of an LAA thrombus in binary logistic regression analysis. Conclusion: The arterial blood serum markers did not differ significantly between groups with and without an LAA thrombus and did not predict an LAA thrombus in patients presenting with AF.Item The Effect of Renal Transplantation on Cardiac Functions(2020) Yilmaz, Kerem Can; Akgun, Arzu Neslihan; Keskin, Suzan; Ciftci, Orcun; Moray, Gokhan; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-8926-9142; 33229768; AAJ-8097-2021; W-5233-2018; AAJ-1331-2021Chronic renal failure is a well-known risk factor for cardiovascular poor outcome. Despite advances in dialysis and renal transplantation, these patients still have high cardiovascular morbidity and mortality. The aim of our study was to evaluate the changes in blood parameters and echocardiographic parameters of patients undergoing renal transplantation in our center. One hundred and eighty-three patients who underwent renal transplantation between September 2012 and January 2016 were included in the study. Pre- and postoperative hemoglobin values, lipid profiles, ejection fractions, presence of left ventricular hypertrophy, presence of diastolic dysfunction, and valve pathologies were retrospectively scanned. Data were obtained from all patients in terms of blood parameters, but we compared 92 patients' echocardiographic data because of lack of both pre- and postoperative echocardiography records. In our study, 124 patients (67.8%) were male, and the mean age was 42.6 +/- 14.4 years. Hemoglobin levels (11.2 +/- 1.98, 12.7 +/- 2.2 mg/dL, P <0.001) and high-density lipoprotein (HDL) values (37.6 +/- 10.5, 46.6 +/- 13.6 mg/dL, P <0.001) were found to be different significantly. In echocardiographic evaluation, there was no difference between pre- and postoperative ejection fractions in 92 patients. However, patients with preoperative ejection fraction <50% had a significant increase in postoperative ejection fraction (40.1 +/- 6.2, 48.4% +/- 9.4%, P = 0.012). Renal transplantation can improve left ventricle ejection fraction in patients with basal ejection fraction less than 50% and also provide a significant increase in hemoglobin and HDL levels in all patients. This suggests that renal transplantation may reverse the process for dilated cardiomyopathy and may improve cardiac function in patients with low ejection fraction. However, transplantation should be performed as early as possible in these patients.Item Evaluation of Ventricular Repolarization Parameters in Patients Admitted to Emergency Department with Electrical Injury(2020) Celik, Casit Olgun; Ciftci, Orcun; Muratoglu, Murat; Muderrisoglu, Ibrahim HaldunObjective: Prolonged T-peak to T-end (Tp-e), a ventricular repolarization parameter, has been related with ventricular arrhythmias (VAs). Novel electrocardiogram (ECG) parameters of ventricular repolarization have received considerable attention recently. In this study, we sought to investigate ventricular repolarization indexes such as the Tp-e and corrected Tp-e (Tp-ec) intervals, Tp-e/QT, Tp-e/QTc, and Tp-ec/QT ratios in patients with electrical injuries (EIs). Methods: Thirty-six patients diagnosed with EIs and 35 age- and sex-matched healthy control patients were included. Admission ECGs of the EI patients were compared with those of the healthy controls. QT and QTc intervals were measured, and the Tp-e and Tp-ec intervals, Tp-e/QT, Tp-ec/QT, and Tp-e/QTc ratios were then calculated from a 12-lead surface ECG. Results: The QT, Tp-e, Tp-e/QT, Tpe/QTc, Tp-ec/QT were not significantly different between the control group and the EI group (p > 0.05). However, the mean QTc interval was significantly higher in the EI group compared to the control group (412.81 +/- 25.46 vs 396.31 +/- 26.47 ms; p:0.009). Furthermore, the Tp-ec and Tp-ec/QT of the EI subgroup with elevated troponin levels significantly differed from those of the EI patients with normal troponin levels (p:0.033 and p:0.016, respectively). Conclusions: This retrospective study indicated that patients with EIs tend to have a prolonged QTc interval. Additionally, Tp-ec and Tp-ec/QT, which reportedly designate the tendency for VAs, were significantly higher in the EI patients with elevated troponin I levels than the EI patients with normal troponin levels, suggesting that patients with myocardial injury may be prone to VAs.Item Adequacy of Infective Endocarditis Prophylaxis Before Dental Procedures among Solid Organ Transplant Recipients(2019) Karacaglar, Emir; Akgun, Arzu; Ciftci, Orcun; Altiparmak, Nur; Muderrisoglu, Haldun; Haberal, Mehmet; 0000-0002-9635-6313; 31464231; AAG-8233-2020Infective endocarditis (IE) is a life-threatening condition with high morbidity and mortality. The current IE guidelines recommend antibiotic prophylaxis only in patients with certain cardiac conditions and before certain dental procedures. However, there is not enough data about solid organ transplant (SOT) recipients. In this study, we aimed to investigate the IE prophylaxis in general dental and periodontal surgical procedures among our SOT recipients. Medical records of 191 SOT recipients (32 liver transplant recipients, 54 heart transplant recipients, and 105 kidney transplant recipients) who were admitted to our hospital between January 2016 and January 2018 were evaluated. A total of 65 patients who underwent dental procedures were included in the study. We investigated the adequacy of IE prophylaxis according to the current guidelines. Two groups were created according to whether they received antibiotic prophylaxis or not. The mean age was 44.2 +/- 13.6 years, and 66.1% were male. The majority of patients (67.6%) received antibiotic prophylaxis. The most commonly used antibiotic was amoxicillin (48.8%). Among the procedures, 23.1% were classified as invasive and 76.9% were classified as noninvasive. No complication was observed after invasive and noninvasive dental procedures. There were no complications in both antibiotic prophylaxis and no-prophylaxis groups. According to our results, IE prophylaxis has been used appropriately in SOT recipients in our center. No serious infection has been reported. In addition, no complication due to antibiotic use was also observed.Item MELD-XI score predicts in-hospital mortality independent of simplified pulmonary embolism severity index among patients with intermediate-to-high risk acute pulmonary thromboembolism(2019) Ciftci, Orcun; Celik, Casit Olgun; Uzar, Guldeniz; Kupeli, Elif; Muderrisoglu, Ibrahim Haldun; 31709948Introduction: Acute pulmonary thromboembolism (PTE) is a highly morbid and fatal condition. Although several risk stratification models exist for prediction of mortality risk in PTE, no study has yet focused on the effect of impaired vital organ function, such as renal or hepatic impairment, on mortality in PTE. MELD-XI (Model for end-stage liver disease excluding INR) score predicts mortality among patients with end-stage hepatic and cardiovascular disorders. Herein, we aimed to test MELD-XI score for predicting in-hospital prognosis of patients with intermediate-to-high risk acute PTE. Materials and Methods: We reviewed the medical records patients older than 18 years hospitalized with intermediate-to-high risk PTE between 01.06.2011 and 01.01.2019. Simplified pulmonary embolism severity index (sPESI) score and MELD-XI score were calculated, and in-hospital mortality determined. MELD-XI score was compared between patients with and without in-hospital mortality and was correlated to sPESI score. The predictive power of MELD-XI score for in-hospital mortality was sought and an in-hospital survival analysis with Kaplan Meier curve and log-rank test was done for MELD-XI score. Results: A total of 104 patients [mean age of 70.8 +/- 15.9 years; 68 (65.4%) females]. Fourteen (13.5%) patients died at hospital. MELD-XI and sPESI scores were significantly correlated to each other and were higher in deceased patients than the survivors [17.3 (IQR 14.3) vs. 10.12 (IQR 2.99); p < 0.05 and 2 (IQR 1) vs. 1 (IQR 1); p < 0.05, respectively]. MELD-XI score and sPESI score were significant predictor of in-hospital mortality in multivariate analysis. A MELD-XI score >= 10.25 had a sensitivity of 78.6% and a specificity of 70.0% for in-hospital mortality. A survival analysis revealed that a high MELD-XI category (MELD-XI score >= 10.2) significantly worsened in-hospital survival (p < 0.01; log rank test). Conclusion: MELD-XI score performs well for mortality prediction among patients with intermediate-to-high risk PTE. This subject needs to be further studied by large, randomized controlled studies.Item MELD-XI Score in Hospitalized Heart Failure Patients with Cardiac Electronic Devices(2019) Ciftci, Orcun; Celik, Casit Olgun; Yilmaz, Kerem Can; Karacaglar, Emir; Sezenoz, Burak; Ozin, Bulent; Muderrisoglu, I. HaldunObjective: MELD-XI (Model for End-Stage Liver Disease Excluding INR) score predicts mortality in patients with heart failure. Herein, we assessed the role of MELD- XI score in predicting in-hospital mortality among heart failure patients having intracardiac cardioverter defibrillator (ICD) or cardiac resynchronization therapy with defibrillator backup (CRT-D) who presented with appropriate device shock or acute decompensated heart failure. Methods: We reviewed the medical records of patients with implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator backup admitted to coronary care unit with acute decompensated heart failure or appropriate implantable device shocks between 01 January 2013 and 01 November 2018. MELD-XI score was compared between the deceased and surviving patients. The correlation of MELD-XI score with in-hospital mortality was sought. Results: There were 106 coronary care unit admissions of 67 patients (52 (77.6%) males and 15 (22.4%) females), who had a mean age of 64.8 (range 19-93) years. Eighty-eight (83.0%) admissions were for acute decompensated heart failure and 18 (17.0%) for appropriate device shock and/or electrical storm. A total of 16 (15.1%) patients died at hospital. The median MELD-XI score of the patients who died at hospital was significantly greater than that of the survivors (11.80 (0.59-28.98) vs 15.24 (9.11-24.64); p<0.05). A binary logistic regression analysis showed that MELD-XI score was a significant independent predictor of in-hospital mortality (X-2=1.229 (%95 CI 1.06-1.43); p<0.05). Conclusion: MELD-XI score successfully predicts in-hospital mortality among patients with ICD or CRT-D admitted with acute decompensated heart failure or appropriate implantable electronic device shocks.Item Preoperative Cardiac Risk Assessment in Renal Transplant Recipients: A Single-Center Experience(2019) Yilmaz, Kerem Can; Akgun, Arzu Neslihan; Ciftci, Orcun; Muderrisoglu, Haldun; Sezer, Siren; Moray, Gokhan; Haberal, Mehmet; 0000-0002-9635-6313; 29025386; AAG-8233-2020Objectives: Cardiovascular disease is the major cause of morbidity and mortality in patients on renal replacement therapy and in kidney transplant recipients. There are no specific recommendations for preoperative cardiac risk assessment before renal transplant. The aim of our study was to analyze preoperative cardiac test frequencies, test results, patient characteristics, and relations between cardiac stress test results and severe coronary artery disease. Materials and Methods: We retrospectively examined patients who underwent renal transplant between December 2011 and December 2016 in our hospital (Ankara, Turkey). Our study group included 216 patients. All patients had preoperative echocardiography. We recorded results of exercise stress tests, myocardial perfusion scintigraphy, and coronary angiography. For all patients, preoperative complete blood cell count, creatinine, high-density lipoprotein, triglycerides, low-density lipoprotein, and red cell distribution width values were obtained and recorded. Results: We classified patient groups according to presence or absence of severe coronary artery disease. Fourteen of 66 patients had severe coronary artery disease. In univariate analyses, age, having a history of familial coronary artery disease, diabetes mellitus, presence of coronary artery disease, and triglyceride levels were risk factors for severe coronary artery disease. In multivariate analysis, diabetes mellitus, presence of coronary artery disease, and having a history of familial coronary artery disease were statistically significant. Conclusions: Renal transplant recipients are a special patient population, and there must be specific suggestions for this population. If patients present with more than 1 risk factor, a stress test should be performed to evaluate cardiovascular risk. In some patients, especially those whose risk factors include prior cardiovascular disease or diabetes mellitus, stress tests should be skipped and patients should directly undergo coronary angiography to look for severe coronary artery disease.