Biomedical subjects
Ilker Mataraci
Publications and source records attributed to Ilker Mataraci.
Comparison of magnesium sulfate with opioid and NSAIDs on postoperative pain management after coronary artery bypass surgery.
OBJECTIVE: This study measured the effectiveness of magnesium sulfate during and after coronary artery bypass grafting (CABG) on postoperative pain and respiratory functions, and compared it with 2 other well-known and widely used analgesic agents: codeine and diclofenac, a nonsteroidal anti-inflammatory drug (NSAID). DESIGN: Prospective unblinded study. SETTING: Single institution. PARTICIPANTS: Patients undergoing CABG. INTERVENTIONS: Patients were divided into 3 groups. In group A (n = 50), intraoperative magnesium sulfate, 2 g/70 kg, was infused intravenously and was continued during the first 3 days postoperatively. In group B (n = 50), codeine, 60 mg/70 kg, was given orally 4 times a day for 3 days. In group C (n = 50), diclofenac sodium, 75 mg, was given orally twice a day for 3 days. MAIN RESULTS: On the first postoperative day the visual analog scale (VAS) score was greater than 5 in all groups. On the second day the VAS score was greater than 5 in groups B and C, and was less than 5 in group A. On the third day the VAS score was less than 5 in all groups. During the first 2 postoperative days the need for morphine was significantly less in group A than in the other 2 groups. Preoperative respiratory function tests (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC], and FEV1/FVC) were similar in each group. The FEV1, FVC, and FEV1/FVC values on the postoperative first, second, and third days were significantly higher in group A. CONCLUSIONS: Magnesium sulfate can be a beneficial adjuvant therapy for pain after CABG. In this respect, especially in patients with respiratory problems or intolerance to NSAIDs, magnesium sulfate can be a better choice than NSAIDs and opioids.
Gastrointestinal complications after cardiopulmonary bypass: sixteen years of experience.
BACKGROUND: Gastrointestinal (GI) complications are one of the serious complications of cardiac surgery. Although rarely seen, they cause major morbidity and mortality. The aim of the present study was to retrospectively analyze the risk factors acting on the GI complications seen after cardiac operations performed under cardiopulmonary bypass. METHOD: The present study was designed to retrospectively evaluate 13,544 patients who underwent cardiac surgery under cardiopulmonary bypass, between 1988 and 2004 in the authors' clinic. RESULTS: The overall mortality was 346 (2.55%) of 13,544 patients. GI complications developed in 128 patients (0.94%). Among those, 18 (14.1%) died because of GI complications, the most common of which was bleeding. Mesenteric ischemia had the highest case-fatality rate at 71.4%. Valve surgery, concomitant valve and coronary artery bypass grafting surgery, preoperative chronic renal dysfunction, postoperative acute renal failure, deep sternal infection, prolonged ventilation, need for intra-aortic balloon pump and ejection fraction less than 30% were found to be risk factors acting on GI complications. CONCLUSION: GI complications remain a significant concern after cardiac surgery under cardiopulmonary bypass. Higher-risk patients can be identified and treated prophylactically and in the postoperative period.
Surgical treatment of the atrial septal aneurysms with concomitant cardiovascular abnormalities.
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[Surgical treatment of peripheral vascular injuries after cardiac catheterization].
OBJECTIVE: Diagnostic and therapeutic cardiac interventions have being performed in expanding numbers during last years. Forty-two cases with peripheral vascular injuries requiring surgical therapy after 64.911 cardiac interventions in our center between 1985 and 2002 were evaluated retrospectively. METHODS: Thirty-three of vascular injuries (78.6%) occurred after angiography/catheterization, and the remaining vascular injuries (21.4%) occurred after angioplasty/stent procedures. There were 12 female (28.6%) and 30 male (71.4%). The mean age was 51.3+/-4.1 years. The localization of the arterial injuries were femoral region in 37 cases (88.1%) and brachial region in 5 cases (11.9%). The complications were recorded as arterial thrombosis in 19 cases, pseudoaneurysm in 14 cases, hematoma in 5 cases, arteriovenous fistula in 2 cases, deformed stent stuck in 2 cases. Arterial injuries were treated by performing embolectomy in 16 cases, embolectomy and saphenous patch plasty in 3 cases, resection of pseudoaneurysm and PTFE patch plasty in 1 case, draining of hematoma and primary repair in 5 cases, primary repair of femoral arteriovenous fistula in 2 cases and removal of the deformed stent from femoral artery in 2 cases. RESULTS: The incidence of vascular complications was significantly higher in brachial interventions when compared with femoral interventions (p<0.0001). The postoperative morbidity was found as 14.3% in our cases. CONCLUSION: The early diagnosis and treatment are very important in peripheral vascular complications after cardiac interventions; otherwise, delay can cause loss of related extremity.
A right atrial thrombus mimicking cardiac tumor after atrial septal defect closure operation.
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Five-year experience in aortic root replacement with the flanged composite graft.
BACKGROUND: Replacement of the aortic root with a composite graft containing a prosthetic mechanic valve is the preferred surgical procedure for tailoring the aortic root. The aim of this study is to determine the 5-year experience with the composite root replacement using our new modification of the Bentall technique. METHODS: Between January 1996 and June 2001, 96 patients underwent aortic root replacement using a flanged composite graft. Eighty patients (83.3%) were male, and 16 patients (16.7%) were female with a mean age of 48.7 +/- 14.4 years. Indications for operation were a true or false aneurysm (65.6%), severe calcified aortic valve stenosis (4.2%) or severe aortic insufficiency (2.1%) with dilated ascending aorta, acute dissection (2.1%), or combination of indications (26%). Thirty-one patients (32.3%) received a concomitant cardiac procedure. Mean aortic cross-clamp time was 89.5 +/- 28.6 minutes, and mean cardiopulmonary bypass time was 146.2 +/- 45.6 minutes. Total follow-up was 253.9 patient-years. RESULTS: Operative mortality was 8.3% (8 patients). The causes of hospital mortality were severe bleeding (3 patients), low cardiac output syndrome (2), acute respiratory distress syndrome (2) and cerebrovascular event (1). No patient died of flange-related complications. Univariate predictors of early mortality were low cardiac output syndrome (p < 0.001), neurologic complication (p = 0.03), and renal complication (p = 0.03). Multivariate analysis demonstrated only low cardiac output syndrome to be significant (p = 0.001) predictor for early mortality. There were five (5.7%) late deaths. Actuarial survival was 82.65% +/- 4.8% at 5 years (1.95% patient-year). Cox proportional hazards regression analysis demonstrated only low cardiac output syndrome to be significant (p = 0.032) predictor for late mortality. Actuarial freedom from prosthetic- and technique-related mortality was 100% at 5 years. CONCLUSIONS: The flanged composite graft offers excellent long-term results, with very low prevalence of prosthetic-related complications. The new created sinuses and the flange are especially helpful to continue physiologic function of the aortic root.
Cardiac hydatid cysts: surgical treatment and results.
From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were diagnosed as a component of multi-organ echinococcosis and three of them underwent operation before. They were examined serologically and echocardiographically. Cardiac hydatidosis were diagnosed in right ventricle (in three cases), left ventricle (in one case), and interventricular septum (in two cases). Sternotomy was the approach used and all patients were operated on using cardiopulmonary bypass. Intraoperative rupture did not occur. There was no operative mortality, the only morbidity was complete atrioventricular block necessitating VVD pacemaker implantation in the patient with hydatid cyst involving the basal interventricular septum. All patients were followed by medical treatment with albendazole (400 mg/day) and no recurrences were reported in the late follow-up.
Does mediastinitis affect the graft patency?
As inflammation began to be recognized as a major contributor to the pathogenesis of atherosclerosis, we evaluated the patients that developed mediastinitis, a long-standing inflammatory process, after coronary artery bypass grafting. There are many studies that have focused on the graft patency. But, till now, no study has been done to detect the effects of mediastinitis to graft patency. So, we aimed to detect the effect of mediastinitis on the graft patency in patients who have undergone coronary artery bypass surgery. Sixteen of 45 patients who have been operated upon for coronary artery bypass surgery and developed mediastinitis, which was treated with open drainage and mediastinal irrigation with late wound closure, were included in the study. The mean age of the patients was 55 +/- 11 (range 35-69) and nine of the patients were male. The graft patency was evaluated with control coronary angiographies after a mean period of 30.42 +/- 43.17 months (range 1-132). The left internal thoracic artery was patent in all patients (100%). Right internal thoracic artery patency rate was 50% (1/2). One individual bypassed radial artery was patent, whereas the sequential bypassed graft was occluded. The patency ratio of radial artery anastomosis was 33% (1/3). Twelve of the 17 saphenous vein grafts were patent (70.58%). The total number of patent distal anastomosis was 30/38 (78.94%). When compared with the graft patency of patients without infection, it was found that mediastinitis does not affect the graft patency rates adversely.