Assesment of Open Heart Surgery Outcome by European System for cardiac risk evaluation (euroscore)

Amaç: Klinigimizde gerçeklestirilen açık kalp cerrahisi uygulamalarının sonuçlarını EuroSCORE sistemine göre degerlendirmektir. Gereç ve Yöntem : Bu çalısmada, Adnan Menderes Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Kliniginde gerçeklestirilen ilk ardısık 300 açık kalp cerrahisi olgusu degerlendirmeye alınmıstır. Hastaların ortalama yası 53±13 yıl idi (14 ile 90 yıl arasında). Hastaların 75'i kadın (%25), 225'i erkek (%75) idi. Tüm hastalarda açık kalp cerrahisi uygulandı; ameliyatlar rutin olarak medyan sternotomi ile kardiyopulmoner bypass altında gerçeklestirildi. Bu hastalara ait ameliyat öncesi 68 ve ameliyat sırasındaki 29 parametre her hasta için ayrı ayrı degerlendirmeye alındı ve EuroSCORE risk skorlama sistemi tarafından risk grupları belirlendi: düsük risk grubu (analitik skor 0-2), orta risk grubu (analitik skor 3-5) ve yüksek risk grubu (analitik skor>5) Üç ayrı grup için hesaplanan skor degerleri ve gerçeklesen mortalite oranları EuroSCORE tarafından belirlenen beklenen mortalite oranları ile karsılastırıldı. Bulgular: Düsük risk grubunda 97 hasta olup beklenen mortalite %1,3±0,3, gerçeklesen mortalite sıfır bulunmustur. Orta risk grubunda 104 hasta olup beklenen mortalite %3,2±0,9 gerçeklesen mortalite %1 (1 hasta) bulunmustur. Yüksek risk grubunda 99 hasta olup beklenen mortalite %26,0±23,7 gözlenen mortalite %14.1 (14 hasta) bulunmustur. Sonuç: Kinigimizde açık kalp cerrahisi düsük mortalite oranları ile gerçeklestirilmektedir.Objective: We aimed to assess the outcome of open heart surgery performed in our department by using EuroSCORE. Material and Methods: In this study, the first 300 consecutive patients who had undergone open heart surgery at Adnan Menderes University Cardiovascular Surgery Department were included. The mean age was 53±13 years (ranged from14 to 90 years). There were 75 females (25%) and 225 males (75%). All patients were operated through median sternotomy under cardiopulmonary bypass. Sixty eight preoperative and 29 peroperative patient related parameters were ealuated for every single patient and three risk groups were identified according to EuroSCORE: low risk group (analytical score 0-2), intermediate risk group (analytical score 3-5) and high risk group (analytical score>5). The actual mortality rates were compared with the predicted mortality rates in each risk group. Results: The actual mortality rate was zero in the low-risk group (97 patients) while the predicted mortality was1.3 ±0.3%. The predicted and actual mortality rates were 3.2±0.9 % and 1%, in the intermediate risk group (104 patients), 26.0±23.7 % and 14.1 % in the high risk group (99 patients), sequentially. Conclusion: Open heart surgery is performed with low mortality rates in our department

Outcomes of standart heparin treatment in deep vein thrombosis

Amaç: Kliniğimizde derin venöz tromboz tanısıyla sürekli unfraksiyone (standart) heparin kullanılarak tedavi edilen olgulara ait sonuçların retrospektif olarak incelenmesi. Yöntem:KliniğimizdeOcak 2002-Nisan 2005 tarihleri arasında derin venöz tromboz tanısıyla tedavi ve takipleri yapılan 44 olgu çalışmaya dahil edildi. Tedavi protokolünde tüm hastalara en az 1 hafta süreyle olmak üzere mutlak yatak istirahati uygulandı. Sürekli intravenöz heparin infüzyonu başlanarak doz a PTT değerlerine göre titre edildi. Oral antikoagülan tedavi başlanarak INR değeri 2'nin üzerine çıkıncaya kadar intravenöz heparin tedavisine devam edildi. Olguların tümünde klinik bulguların yanı sıra tanısal olarak renkli doppler USGtetkiki kullanıldı. Bulgular: Yaş ortalamaları 43,2 olan olguların, 27'si erkek (% 61,3) ve 17'si kadın (%38,7) idi. Olguların % 4.5'inde pulmoner emboli saptandı. Pulmoner emboli gelişen olgularda mortalite gözlenmedi.Heparin tedavisine olguların%45'inde 5-6. gün,%36'sında 7-10. gün devamedildi. 24 hastada yatışının 0-3. gününde, 20 hastada da 4-7. gününde oral antikoagülan tedaviye başlandı. Tedavi süresince hiçbir olguda majör kanama komplikasyonu ya da mortalite gözlenmedi. 3 aylık takipte hiçbir olguda rekürren tromboembolizm ile karşılaşılmadı. Sonuç: Derin venöz trombozda devamlı unfraksiyone heparin tedavisinin güvenle uygulanabilecek bir yöntem olduğu görüşündeyiz.Aim: In this retrospective study we aimed to investigate the outcomes of continuous unfractioned ( standart ) heparin treatment for deep vein thrombosis. Methods: 44 patients who were hospitalized between January 2002 and April 2005 with the diagnosis of deep vein thrombosis are included in this study. Strict bed rest was applied in treatment protocol to all cases. Continious intravenous heparin infusion was started and the dosage was titrated regardinga PTT values. Patients were put on oral anticoagulant therapy and intravenous heparin was continued until the INR value is greater than 2. Besides clinical findings colour Doppler USG was used diagnostically. Results: The mean age of the patients was 43.2 and 27 were male ( % 61.3 ) and 17 were female ( %38.7 ). Pulmonary embolism was detected in 4.5 % of cases. There was no mortality in patients who had pulmonary embolism. Heparin treatment was continued for 5-6 days in 45 % of cases and for 7-10 days in 36 % of cases. In 24 of cases oral anticoagulant therapy was started on0 - 3 rd day of hospitalization while in 20 of them therapy was started on4 - 7 th day of hospitalization. No mortality or major bleeding complication ocuured during the course of therapy. Neither of the cases faced reccurent thromboembolism in 3 months follow up. Conclusion: Unfractioned heparin treatment can be suggested asa reliable method for the treatment of deep vein thrombosis

Effects of blood cardioplegia with deferroxamine on myocardial nitric oxide production and myocardial performance

Amaç: Bu çalişmada rutin kullanilan kan kardiyoplejisi ile deferoksaminli kan kardiyoplejisinin sol ventrikül fonksiyonlari üzerine etkileri, myokardiyal Nitrik Oksit (NO) düzeyleri ve hemodinamik parametreler karşilaştirilarak değerlendirildi. Yöntem: Aortakoroner bypass operasyonu olan 20 elektif hasta üzerinde çalişma yapildi. Hastalar kontrol ve çalişma grubu olarak 10 ar kişilik 2 gruba ayrildi. Kontrol grubunda yaş ortalamasi (61.30+2.12), çalişma grubunda ise (53.20±3.21) idi. Her iki grupta distal anastomoz , X- klemp, Kardiyopulmoner bypass (CPB) süreleri benzer değerlerdeydi (p>0.05). Kardiyopleji iki gruba da antegrad yoldan verildi. Kan örnekleri koroner sinüsten alinarak ölçümler yapildi. Hemodinamik parametreler CPB öncesi ve sonrasinda ayri ayri değerlendirildi. Bulgular: Çalişma grubunda NO düzeyleri tüm örneklemelerde yüksek bulundu ancak yalnizca CPB sonrasinda istatistiksel olarak anlamli idi. Myokard hasarinin bir göstergesi olan kreatin kinaz MB izoenzim (CK-MB) değerleri çalişma grubunda daha düşük düzeyde bulundu (p< 0.05). Her iki grup arasinda hemodinamik olarak bir farklilik gözlenmedi. Sonuç: Bu bulgular, deferroksaminli kan kardiyoplejisi kullanilan vakalarda endotel fonksiyonlarinin daha iyi korunduğunu ve myokard hasarinin daha az olduğunu göstermektedir. Deferroksaminli kan kardiyoplejisi açik kalp cerrahisinde aortik kross klemp esnasindaki myokard korunmasinda iyi bir seçenektirObjective: The effects of deferroxamine addition to routine blood cardioplegia on left ventricular function, myocardial nitric oxide (NO) production and hemodynamics were assessed. Methods: Twenty patients who underwent coronary artery bypass grafting (CABG) electively were studied in two groups, 10 in each. Ten patients in whom routine blood cardioplegia was used served as controls. In the other 10 patients (study group), blood cardioplegia with deferroxamine was used. Mean age was 61.30+2.12 in the control group, and 53.20±3.21 in the study group. The number of distal anastomoses, X-clamp and cardiopulmonary bypass (CPB) times were similar in two groups. Cardioplegia was delivered antegradely in both groups. Blood samples were taken from the coronary sinus. Hemodynamic measurements were done before and following CPB. Results: In the study group, myocardial NO levels were found to be higher at all sampling times, however, the difference was statistically significant only following CPB. Creatine kinase MB isoenzyme levels reflecting the degree of myocardial injury were measured lower in the study group postoperatively(p<0.05). There was no difference in hemodynamics between the two groups. Conclusions: These findings demonstrate that the addition of deferroxamine to blood cardioplegic solution maintains higher myocardial NO levels indicating better endothelial function and causes less myocardial injury. Blood cardioplegia with deferroxamine is a valuable alternative method of myocardial protection during aortic cross clamping in cardiac surgery

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Aspartat ve glutamatlı kan kardiyoplejisinin miyokardial nitrik oksid (NO) üzerine olan etkileri

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