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D Baykut

Publications and source records attributed to D Baykut.

14 recordsLinked to original sources
PubMed2006

Impact of female gender on the early outcome in off-pump coronary artery bypass surgery.

BACKGROUND/OBJECTIVE: Female gender is an independent risk factor for adverse outcome after conventional coronary bypass surgery (CABG). The objective of this retrospective study was to evaluate the influence of the gender on the early outcome in "off pump" coronary bypass surgery without extracorporeal circulation (OPCAB). PATIENTS AND METHOD: Between January 2001 and December 2003, a total of 225 patients, 49 female and 176 male, underwent OPCAB surgery for multivessel disease at our institution. Operations were performed by the same surgeon. The relationship between OPCAB surgery and clinical outcome with major and minor adverse events was assessed with univariate analysis. RESULTS: The same operative technique was applied for both female and male patient groups. No conversion to conventional CABG with cardiopulmonary bypass was necessary. The overall in-hospital mortality was 1.3% (3 of 225 patients), all of them in the male patient group (p = 0.08). Female patients showed a lower rate of postoperative atrial fibrillation than male patients (6% vs. 15%; p = 0.08). The incidence for further postoperative complications such as rethoracotomy for bleeding, stroke, delirium, pneumonia and wound infection was identical and statistically not different in both groups. CONCLUSIONS: In OPCAB surgery, female gender plays not a predictive role for postoperative adverse events and complications influencing morbidity and mortality. In selected female patients OPCAB surgery has a beneficial effect on early clinical outcome.

Aged↗
PubMed2003

The value of heparin concentration monitoring in off-pump coronary bypass surgery.

BACKGROUND/OBJECTIVE: In recent years, a remarcable increase in off-pump coronary bypass surgery (OPCAB) was observed. The identical anticoagulation treatment in cardiac surgery with cardiopulmonary bypass (CPB) and OPCAB makes the hemodynamic management in OPCAB procedures essential, since a perioperative compensation of blood loss is difficult and the hemodynamic stability has to be maintained by infusions. The aim of this study was to evaluate the circulating heparin concentration measurement in OPCAB patients by using the heparin/protamine titration method with Hepcon/HMSplus (HMS). PATIENTS AND METHOD: In 8 patients (3F/5M) undergoing elective OPCAB, the calculated heparin dose was administered and heparin concentration was registered together with activated clotting time (ACT) 5 min after administration. Measurements were carried out in 45 min periods and additional heparin was administered if the measured heparin concentration was lower than the calculated. The protamin dose was also automatically calculated by HMS. RESULTS: The mean operation time was 155 +/- 36 min (80-210) with 2.3 bypass grafts per patient. There was a significant difference between the demand for heparin as determined by HMS and the conventionally calculated value (p<0.05). Similarly, the calculated and measured concentration of heparin diverged significantly from each other (p<0.05), independent of ACT. In spite of an initially higher administration of heparin as calculated by HMS, the concentration of circulating heparin was below the estimated value in 7 patients which made a further administration of heparin necessary. The 24 h postoperative blood loss was 550 +/- 176 mL (300-850). No rethoracotomy for bleeding was necessary. CONCLUSIONS: HMS could be a useful method for appropriate anticoagulative treatment in OPCAB procedures, if there is a sufficient hemodynamic management with restrictive administration of infusions guaranted during surgery.

Aged↗
PubMed2001

New surface biopolymers for oxygenators: an in vitro hemocompatibility test of poly(2-methoxyethylacrylate).

BACKGROUND/OBJECTIVE: The continuous interaction of blood with artificial contact surfaces under cardiopulmonary bypass can lead to a substantial damage of blood cells and plasma factors. Surface biopolymers in oxygenation systems can help increasing the hemocompatibility, often combined with anticoagulative agents such as heparin. The poly(2-methoxyethylacrylate) [PMEA] is a new heparin-free polymer. The objective of this experimental study was to evaluate the hemocompatibility of a PMEA-coated oxygenator (Terumo Capiox RX-25) (PTX) under standardized in vitro conditions compared to two ionic-bound and one covalent-bound heparin-coated models. METHOD: Each oxygenator was mounted in a separate standardized closed circulation system. Heparinized (5 IE/mL) fresh human blood from the same donor (hemodilution: Ringer's solution) was used. Circulation time: 120 - 180 min with a flow rate of 4.0 L/min. Blood samplings: at the beginning, 5. min and every 30 min of the circulation. PARAMETERS: platelets, granulocytes, plasma factors (p-selectin, alpha-granulomeres expression, and TAT(III)-complex). After the experiment, oxygenators were dismantled and examined by scanning electron microscopy. RESULTS: All of the oxygenators led to an initial reduction of platelets and granulocytes. PTX had the lowest platelet and granulocyte reduction rates. With a lower p-selectin release compared to covalent-bound heparin-coated oxygenator and higher expression of alpha-granulomeres compared to ionic-bound heparin-coated oxygenators, the results of PTX indicated that a high number of circulating platelets were intact on the PMEA surface. TAT(III)-complex showed a steady increase in all of the oxygenators during the tests, more remarkably in PTX. In contrast to ionic-bound heparin-coated oxygenators, the electron microscopy displayed virtually no cellular accumulation on hollow fiber and housing surfaces of PTX and covalent-bound heparin-coated oxygenator. CONCLUSIONS: 1. The hemocompatibility characteristics of PTX were remarkably better than ionic-bound heparin-coated oxygenators and slightly better than the covalent-bound heparin-coated model under in vitro conditions. 2. The PMEA coating can be a useful alternative for patients with heparin-associated disorders. 3. The clinical feasibility of PTX should be evaluated under in vivo conditions.

Acrylates↗
PubMed2001

Online detection of myocardial ischemia by near infrared spectroscopy with a fiberoptic catheter.

BACKGROUND: The interruption of myocardial O2-supply in acute myocardial ischemia causes differences in coronary venous O2-content. In this study, the oxygenation status of coronary sinus blood is detected in myocardial ischemia by near infrared (NIR) spectroscopy. METHOD: For the intravascular application, a new fiberoptic catheter is developed. After calibration of the catheter by perfusion of blood with standardized gas mixtures in an in vitro experiment, the in vivo application was performed in 12 domestic pigs. The catheter was placed into coronary sinus and an anterior ischemia was induced by temporary occlusion of LAD. NIR graphs and hemodynamic data were obtained for 90 min ischemia and 90 min reperfusion time. RESULTS: Main NIR-spectroscopic differences between oxygenated and de-oxygenated hemoglobin took place in O2-concentrations less than 30%. Coronary sinus NIR spectra of hemoglobin-oxygen binding showed significant, reproducible differences between pre-ischemia, LAD-occlusion and reperfusion. NIR graphs also show variations related to CO2-concentration, pH and temperature. CONCLUSION: The intravascular application of NIR spectroscopy could be a reliable tool in detection and follow-up of acute myocardial ischemia and infarction.

Animals↗
PubMed2001

[Intravascular detection of myocardial ischemia by spectrometry in the near infrared spectrum in experimental animals].

Interruption of oxygen supply in acute myocardial ischaemia reduces venous return of oxygen at the coronary sinus. In this study, the oxygen content of venous return in the coronary sinus was measured by using spectrometry in the near infrared spectrum. The authors developed a new intravascular catheter made of fibre optics. After in vitro calibration by blood flow based on a standard gas mixture used in in vitro experiment, an in vivo application in 12 domestic pigs was undertaken. The catheter was positioned in the coronary sinus and ischaemia induced by temporary occlusion of the left anterior descending artery. Recordings of the near infrared spectrum and haemodynamic data were obtained during 90 minutes' ischaemia followed by 90 minutes reperfusion. Spectrometry in the near infrared range detected a marked difference between oxyhaemoglobin and deoxyhaemoglobin, especially when the oxygen concentration was less than 30%. The near infrared spectrum of liaison between haemoglobin and oxygen in the coronary sinus shows significant and reproducible differences between pre-ischaemia occlusion of the left anterior descending artery and reperfusion. The recordings of the near infrared also show variation in CO2, pH and temperature. The authors conclude that the use of intravascular spectrometry of the near infrared spectrum could be a permanent reliable tool for detection and follow-up of acute myocardial ischaemia.

Animals↗
PubMed2000

The value of procalcitonin as an infection marker in cardiac surgery.

BACKGROUND/OBJECTIVE: Cardiopulmonary bypass generally leads to an unspecific increase of inflammatory parameters after cardiac operations. Increased Procalcitonin (PCT)-levels in serum, particularly after contamination with bacterial endotoxines, can be used as a marker for specific infections. The objective of this prospective study was to evaluate the course of PCT after cardiac surgery for the differential diagnosis of infections/unspecific inflammatory reactions, compared to routine infection parameters. METHOD: Serum PCT levels were measured in 400 routine cardiosurgical patients preoperatively and at 1., 2., 4. and 6. postoperative days with a luminescence immunoassay. PCT-values were compared to the patient's clinical infection status, body temperature, leukocyte count and C-reactive protein (CRP). RESULTS: 364 patients had an infection-free postoperative course, 27 patients developed infections. All of these patients showed elevated infection parameters at 1-2. postoperative days. In patients without infection, these parameters decreased after 2. postoperative day. Patients predisposed to an infection had continuously high temperature, leukocytes, CRP and PCT until 4.postoperative day with leukocytes and CRP decreasing after 4.postoperative day. PCT however showed a divergent course with a second increase in these patients between 4.-6. postop day (p<0.001). At this time, no clinical sign of an infection was evident. The increase of PCT was independent of infection type, but most apparent in bacteriemia/sepsis. CONCLUSION: Based on its different course from other parameters in infection development between 4.-6. days, PCT can probably be used as a predictive marker in bacterial infections after cardiac surgery. The cost of the used immunoassay however will set the limits for a routine application.

Adult↗
PubMed2000

Ectopic thyroid tissue in the left ventricular outflow tract.

Ectopic thyroid tissue in the heart (struma cordis) is rare. The only report from a hemodynamically significant obstruction of the left ventricular outflow tract (LVOT) by a heterotopic thyroid gland was published in 1988. In our patient, a 42-year-old woman with recurrent chest pain, two spheric cardiac tumors were diagnosed by transthoracal echocardiography. One of the tumors, obstructing the LVOT, could successfully be resected under cardiopulmonary bypass. The pathologic examination showed a colloid-filled ectopic thyroid gland. The second tumor, which was entirely located in the submembraneous part of the interventricular septum, had no hemodynamic influence, and was left in situ to avoid surgical damage of adjacent intraseptal structures. The midterm follow-up showed no recurrence.

Adult↗
PubMed1993

A new sternal retraction device for the dissection of the internal mammary artery.

For the dissection of the internal mammary artery (IMA), we use a new sternal retraction technique. The retractor is an angled stainless steel device with a slotted face and two sternal arresting hooks. The method is simple and the device acts as a unit with a standard sternal spreader. The time period between mounting and the exposure of the IMA is only a few seconds. The entire procedure takes place in the sterile operative field. By utilizing this method, we dissected nearly 300 IMAs without any complications or serious sternal injuries.

Dissection↗
PubMed1990

Experimental balloon valvuloplasty of fibrotic and calcific mitral valves.

This study evaluated the mechanism of valvular area expansion during single- and double-balloon valvuloplasty in fibrotic and calcific mitral valves. Special interest was focused on the morphological features of the valves treated. Mitral valves that appeared unsuitable for commissurotomy were excised in toto at the time of mitral valve replacement in 15 patients. The excised valves were mounted in a fluid-filled chamber with a window for photographic evaluation. The chamber was perfused continuously to ensure maximal valvular opening. The valve was photographed, and the orifice area was measured before and after balloon expansion. In addition, the specimens were examined macroscopically and radiographically with regard to calcium content and degree and localization of fibrosis. These data were correlated with splitting of commissures and with rupture of leaflets. Nine valves were fibrotic, and six were calcific. Dilatation was performed first with a single-balloon catheter (diameter, 2 cm) and then with a double-balloon catheter (diameter, 2 and 1.5 cm). After dilatation with one balloon, the average mitral valve area increased from 0.79 to 1.09 cm2, and with two balloons, average area increased to 1.59 cm2. The single-balloon technique caused commissural splitting in nine valves, stretching in three, partial leaflet rupture in one, and no change in two. After the double-balloon technique, commissural splitting occurred in 12 valves and three leaflets were ruptured where severe fibrosis and calcification were mainly located within the commissures. As a rule, after dilatation with the single-balloon technique, the remaining stenosis was still severe, and after dilatation with the double-balloon technique, the remaining stenosis was moderate.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcinosis↗
PubMed1986

[Two-dimensional echocardiography in the quantification of severe mitral stenosis].

The aim of the study was to evaluate the accuracy of echocardiographic quantification of mitral valve opening area in severe mitral stenosis. 31 consecutive patients with severe mitral stenosis were studied with two-dimensional echocardiography before they had complete resection of the mitral valve. The valves were examined for calcifications by x-ray. Each specimen was tensionlessly suspended in a glass cylinder, with 10 to 15 l of warm water (37 degrees C) running through it until maximal opening of the valve. Then the valvular orifice was photographed for planimetry. Now the echocardiographic results were checked again to analyse the errors of the initial assessment. In 6 out of 31 patients the size of the valvular opening area could not be assessed echocardiographically due to poor echo quality. The mean mitral opening area of the specimens was 0.92 +/- 0.32 cm2. With 1.27 +/- 0.52 cm2, the results achieved by echocardiography reached a correlation of only r = 0.44. In 9 out of 25 patients the area was assessed precisely in terms of size and anatomy. The difference between the values calculated from the specimens and echocardiograms was below 0.5 cm2 in 19 out of 25 (76%) patients and below 1 cm2 in another 4 (16%) patients. A larger difference in two patients was due to incorrect beam direction. Otherwise, false results in 10 out of 25 patients were caused by multiple inner echoes and in 2 out of 25 patients by bright reflections due to calcifications. Although the echocardiographically assessed mitral valve opening area does not correlate with the real opening area, it is possible to distinguish in most patients between severe and mild stenosis. Furthermore the valvular opening area can be exactly determined up to 0.5 cm2 in 90 percent of patients, provided that the echo beam is correctly positioned.

Adult↗
PubMed1985

[In vitro study of transvenous commissurotomy in severe mitral valve stenoses using the balloon catheter].

To answer the question whether mitral commissurotomy with a balloon catheter is possible, the following in vitro study was performed. In 12 patients who were operated due to severe mitral stenosis the fibrotic (n = 8) or calcified (n = 4) valves were excised and mounted in a glass cylinder. In a first step a valvuloplasty was performed with a balloon catheter (size 20 mm). Mitral valve area increased by about 40%. With simultaneous inflation of a second balloon catheter (size 15 mm) valve area increased more than 100% and reached 1.63 cm2 in the mean. Valvuloplasty was successful (increase of at least 0.5 cm2) in 11/12 cases. In 9 valves the rupture occurred within the commissures, twice within the leaflets and once the opening area increased due to dilatation. Commissurotomy with a balloon catheter seems to be possible even in calcified mitral valves although in most cases a mild to moderate stenosis will remain.

Adult↗
PubMed1984

[Hemodynamic and echocardiographic long-term results of closed mitral commissurotomy].

During recent years open mitral commissurotomy (OMC) has seemed to be more favorable than closed commissurotomy (CMC). Up to now only few long-term results including hemodynamic data of mitral valve reconstruction have been reported. 69 of the 103 patients who underwent CMC between 1973 and 1980 were followed over a mean period of 5.3 +/- 2.1 years after intervention. 5 patients died. In 8 (11%) a prosthetic valve replacement was necessary (restenosis 4, insufficiency 2, combined valve disease 2). 36 of the patients were clinically improved (at least 1 NYHA class), 21 (30%) maintained the same NYHA class, and 7 (10%) had deteriorated. The relative heart volume (HV) from supine chest X-rays decreased from 1010 ml/1.71 m2 to 906 ml/1.73 m2 (n = 42, p less than 0.01). The mitral valve area ( MOFL ; n = 25) increased from 1.2 cm2 (Gorlin formula) to 2.6 cm2 (2D-echo) (p less than 0.001). Mean pulmonary artery pressure ( MPAP ) at rest decreased by 29% (from 33.6 mm Hg to 23.8 mm Hg, n = 37, p less than 0.001) and during exercise by 36% (from 69.5 mm Hg to 44.8 mm Hg, n = 10, p less than 0.01). The reduction in PA pressures and the increase in mitral valve area did not correlate and showed no relationship to the intraoperatively estimated success of commissurotomy. Our findings reflect very satisfactory long-term results after closed commissurotomy, which are comparable with those of open valvotomy.

Adolescent↗