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Item Comparison of Platelet Mass Index in On-Pump and Off-Pump Coronary Artery Bypass Surgery(2020) Gunday, Murat; Ciftci, Ozgur; 32364905Introduction: Platelet mass index (PMI) is calculated by multiplying platelet count and mean platelet volume (MPV). It demonstrates platelet activation and is thought to be associated with inflammation. Its importance for cardiac surgery has not yet fully been clarified. This study investigates whether there is a difference between PMI levels after on-pump and off-pump coronary artery bypass surgery and the relationship between early postoperative complications and PMI. Method: In our hospital, 138 patients were included in the study retrospectively. The patients were divided into 2 groups: Group 1 (on-pump) with 80 patients (22 females, 58 males, mean age 61.54 +/- 8.68) and Group 2 (off-pump) with 58 patients (15 females, 43 males, mean age 61.34 +/- 10.04). In biochemical analysis, hemoglobin, platelet, white blood cell, and MPV values of the patients were evaluated in the biochemistry laboratory of our hospital with the blood taken preoperatively from the forearm veins and postoperatively on the first, third, and seventh days and, on average, after the first month. Results: There was a statistically significant difference between postoperative first day thrombocyte (K/mu L) (P = .005), postoperative first day PMI (P = .014), postoperative first day leukocyte (K/mu L) (P = .001), postoperative first day Hb (g/dL) (P = .001), postoperative third day thrombocyte (K/mu L) (P = .003), postoperative third day PMI (P = .031), postoperative third day leukocyte (K/mu L) (P = .004), and postoperative seventh day leukocyte (K/mu L) (P = .002). There was no meaningful relationship between PMI and early postoperative complications. Conclusion: We think PMI is a more valuable indicator than MPV as an inflammation marker in cardiac surgery. In our opinion, PMI is a cheap and valuable inflammation marker that can be used in coronary surgery that can be obtained from routine hemogram test and can easily be evaluated.Item Is there a difference between two different skin disinfection methods in cardiac surgery in terms of isolated pathogens?(2020) Gunday, Murat; Orhan, Atilla; Turan, Hale; Korez, Muslu Kazim; 32683356Introduction: In this study, our aim was to prospectively compare the different methods of patient disinfections with scrubbing + iodine + alcohol, and the povidone iodine disinfection method, which can be described as classical, in terms of the pathogens isolated on skin and during early postoperative complications. Methodology: Eighty patients undergoing a coronary artery bypass operation were included in the study. The patients were divided into two groups: group 1 (n = 48) patients who underwent scrub, iodine, followed by skin disinfection with alcohol, and group 2 (n = 32) who were treated with povidone iodine three times. The samples were immediately sent to the microbiology laboratory. Specimens from the wounds were incubated under aerobic and anaerobic conditions, and isolates were identified using standard microbiological techniques. Results: In samples taken after disinfection in group 1, significantly less reproduction was observed compared to group 2 (p = 0.001). There was no difference in postoperative complications between the two groups except for pleural effusion (p = 0.040). S. epidermidis was the most frequently isolated pathogen in both groups. Conclusion: We did not find a study which compares scrub + alcohol + iodine and povidone iodine in our literature review. We think that our study is original in this respect. We can conclude that skin disinfection with scrub + alcohol + iodine was superior to using only povidone iodine in terms of the pathogens isolated afterwards from the wound.Item Is crystalloid cardioplegia a strong predictor of intra-operative hemodilution?(2014) Gunday, Murat; Bingol, HakanIntroduction: Complications due to hemodilution (hematocrit value less than 22%) after cardiopulmonary bypass inevitably resulted with significantly greater intensive care requirements, long hospital stays, more operative costs, and increased mortality rates. We tried to identify whether crystalloid cardioplegia is the strongest predictor of intraoperative hemodilution or not. Materials and methods: One hundred patients were included into this randomized prospective study. Patients were divided into the two groups. Crystalloid cardioplegia were given to the odd-numbered patients (Group 1, n = 50 patients) and blood cardioplegia were given to the even-numbered patients (Group 2, n = 50 patients). St. Thomas-II solution was used in Group-1 and Calafiore cold blood cardioplegia was in Group-2. Results: Average intraoperative hematocrit value was 18.4% +/- 2.3 in crystalloid group 24.2% +/- 3.4 in blood cardioplegia group (p < 0.001). The lowest hematocrit value was 15% and 20% in two groups respectively (p < 0.001). In crystalloid group average intraoperative packed red blood cell (RBC) transfusion was 2.3 +/- 0.41 units, 0.7 +/- 0.6 units blood cardioplegia group (p = 0.001). Average transfused RBC was 2.7 +/- 0.8 units in crystalloid group, 0.9 +/- 0.4 units blood cardioplegia group (p < 0.001). Multivariate analyses confirmed age (p = 0.005, OR = 3.78), female gender (p = 0.003, OR = 2.91), longer cross-clamp time (>60 minutes) (p = 0.001, OD = 0.97), body surface area <1.6 m(2) (p = 0.001, OR = 6.01) and crystalloid cardioplegia (p < 0.001, OR = 0.19) as predictor of intraoperative hemodilution. Conclusion: Crystalloid cardioplegia, compared to blood cardioplegia not only causes much more intra-operative hemodilution but also increases the blood transfusion requirement. Hemodilution and increased transfusion increases the intensive care unit and hospital stay, in the early postoperative period.Item Effects of Cardiopulmonary Bypass on Mediastinal Drainage and the Use of Blood Products in the Intensive Care Unit in 60-to 80-Year-Old Patients Who Have Undergone Coronary Artery Bypass Grafting(2015) Aygun, Fatih; Ozuklu, Mehmet; Gunday, Murat; 26934397Objective: The present study consisted of patients who underwent on-pump coronary artery bypass grafting (CABG) and off-pump CABG and investigated effect of using cardiopulmonary bypass (CPB) on the amount of postoperative drainage and blood products, red blood cell (RBC), free frozen plasma (FFP) given in the intensive care unit in 60-80-year-old patients who underwent CABG. Methods: The present study comprises a total of 174 patients who have undergone coronary artery bypass graft (off-pump or on-pump CABG) surgery in our clinic in between 2012-2015 year. Results: It was observed that the amount of drainage in the first 24 postoperative hours was lower in the on-pump CABG group (Group 1) when compared to off-pump group (Group 2) (Group 1 vs. Group 2; 703.5 +/- 253.8 ml vs. 719.6 +/- 209.4 ml; P=0.716). However, the amount of drainage in the second 24 hours was statistically significantly lower in the off-pump CABG group (Group 1 vs. Group 2; 259.8 +/- 170.6 ml vs. 190.1 +/- 129.1 ml; P=0.016). With regard to the amount of overall drainage, no statistically significant difference was observed between the two groups. Group 1 needed RBC transfusion higher than Group 2 (Group 1 vs. Group 2; 2.2 +/- 1.3 bag vs. 1.2 +/- 0.9 bag; P<0.001). Conclusion: We can say that CPB influences the amount of second 24-hour drainage which indexed body surface area. In addition, CPB decreases hct, hb, thrombocyte count in ICU arrived, after 24 hours in postoperative period. Reduced thrombocyte counting effect can be appeared after 48 hours in the postoperative period of CPB.